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@#Objective To investigate the safety of thoracic surgery for high-altitude patients in local medical center. Methods We retrospectively collected 258 high-altitude patients who received thoracic surgery in West China Hospital, Sichuan University (plain medical center, 54 patients) and People's Hospital of Ganzi Tibetan Autonomous Prefecture (high-altitude medical center, 204 patients) from January 2013 to July 2019. There were 175 males and 83 females with an average age of 43.0±16.8 years. Perioperative indicators, postoperative complications and related risk factors of patients were analyzed. Results The rate of minimally invasive surgery in the high-altitude medical center was statistically lower than that in the plain medical center (11.8% vs. 55.6%, P<0.001). The surgical proportions of tuberculous empyema (41.2% vs. 1.9%, P<0.001) and pulmonary hydatid (15.2% vs. 0.0%, P=0.002) in the high-altitude medical center were statistically higher than those in the plain medical center. There was no statistical difference in perioperative mortality (0.5% vs. 1.9%, P=0.379) or complication rate within 30 days after operation (7.4% vs. 11.1%, P=0.402) between the high-altitude center and the plain medical center. Univariate and multivariate analyses showed that body mass index≥ 25 kg/m2 (OR=8.647, P<0.001) and esophageal rupture/perforation were independent risk factors for the occurrence of postoperative complications (OR=15.720, P<0.001). Conclusion Thoracic surgery in the high-altitude medical center is safe and feasible.
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Background: Road Traffic Accident is an incident on a way or street open to public traffic. It becomes one of the most significant public health problems in the world especially in developing countries. In Ethiopia, it represents a significant risk for morbidity and mortality. It is also the major public health problem even though studies done on this topic in the study area is limited. Objective: To assess clinical pattern, associated factors and management outcomes among road traffic accident Victims attending emergency department of Jimma University Medical Center. Methods: Hospital based cross sectional study design was employed to review patients' chart visited the hospital from March to April 2021. A systematic random sampling technique was applied. The data were collected using pretested checklist and analyzed using SPSS version 26. Descriptive statistics and multivariate logistic regression were computed. Variables with P<0.05 were considered statistically significant. Results: About 49.6%) were pedestrians injured of which motorcycle accounted 42.9%. More than half of victims never got any type of prehospital care. On arrival, 38.7% were classified as Red of which 71.4% of them were managed surgically. About 84.9% of victims were discharged with improvement whereas12.6% were died. Victims with head injury (AOR= 16.61: 95% CI; 3.85, 71.71), time elapsed to reach nearby health facility (AOR= 3.30; 95 CI (1.13, 9.60), condition of patient at Emergency Department (AOR= 7.78; 95% CI: 2.33, 26.06), GCS at admission (AOR= 20.12; 95% CI: 7.23, 55.96) and days spent in hospital (AOR= 6.85; 95% CI 5.81, 8.06) were independent predictors of unfavorable outcome. Conclusion: Road Traffic Accident represents a significant risk for morbidity and mortality in Ethiopia, of which head injury and multiple sites injury increase injury severity. Targeted approaches to improving care of the injured victims may improve outcomes. Thus, the clinician should take into consideration the clinical presentation and give due attention to the identified contributing factors in its management.
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Humans , Male , Female , Wounds and Injuries , Accidents, Traffic , Traffic , Risk Factors for Traffic Accidents , Motor VehiclesABSTRACT
China national medical centers and national regional medical centers are the key entities to expand the availability of quality medical resources and ensure they are better distributed among regions. It is of great significance for the centers′ high-quality development to understand the key issues in the construction and progression of centers by evaluating the performance of their function fulfillment. The evaluation framework of this study was based on the " structure-process-outcome" model. The study was divided into three stages, including centers′ self-evaluation, data reporting, and on-site investigation and evaluation. The team conducted the evaluation on 15 entity hospitals supporting 6 national medical centers and 5 national regional medical centers that had been approved by October 2020. As the results showed, the funding and policy support for these centers from governments at all levels were increased, the internal and external management mechanism of the centers were preliminarily set up, the functions of the centers were executed properly, and the " radiation effect" of the centers was in place gradually. The key problems hindering the fulfillment of functions concern the mechanisms that were not sound and need to be further refined, which included the field of financial investment and policy guarantee for the entity hospitals, internal and external management of centers, introduction and cultivaton of the talented, and the innovation and transformation of scientific achievements which facilitates breakthroughs in core technologies. To promote the efficient implementation of functional tasks of the centers, the authors proposed four suggestions. First, the " commission and province co-construction" mechanism should be further improved to augment investment and policy guarantee from the government. Second, the internal organization and management mechanism of each centers should be optimized. Third, the reform and innovation in the training and management system of the talented medical personnel should be accelerated. Last, the health needs oriented mechanism for scientific research innovation and achievements transformation should be established.
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The authors took the management practice of " one hospital with multiple districts" in Children′s Hospital Affiliated of Zhengzhou University as the research object, analyzed the main problems and challenges faced by the multi-district hospital management under the new pattern of national regional medical center. Through coordinating the hospital′s strategic planning and the development of discipline layout, building an integrated management system, improving the level of homogeneous service and other key countermeasures, the hospital has significantly improved its management efficiency and operation efficiency, and the medical service capacity of each district has developed in a balanced way. It could give full play to the pilot value for the construction of national regional medical center, hoping to provide reference for hospital administrators.
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As guided by the policy of building national regional medical centers, it is imperative to advance the construction of the national regional medical centers for mental health to achieve the sustainable and balanced development of the mental health cause of the country. The authors summarized the current status of national regional medical centers, and analyzed challenges faced in management and operation mode, government investment and compensation mechanism, expansion of high-quality psychiatric medical resources, as well as research and innovation of mental diseases of these centers. On such basis, the authors put forward corresponding countermeasures and suggestions for the next stage of development.
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【Objective】 According to the need and practice of the National Medical Center Construction, this study structures the project communication management framework of the National Medical Center Construction based on Boyd/OODA loop and describes its background and practical path so as to explore its implementation efficiency. 【Methods】 The theoretical framework was constructed and applied by means of lessons learned and case analysis. 【Results】 The framework can meet various needs of project communication management of the National Medical Center Construction at different stages of epidemic prevention and control. 【Conclusion】 The framework can improve the effectiveness, systematicness, coordination and efficiency of the National Medical Center Construction, and provide theoretical and empirical underpinning. Considerably more innovative and interdisciplinary research is needed in communication management.
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La pandemia del COVID-19 destaco la importancia y la utilidad de la telemedicina para proporcionar una manera de poner en contacto a pacientes y profesionales de la salud cuando no es posible una consulta en persona en las zonas rurales. Se realizó una revisión sistemática de la Telemedicina y su impacto en la atención médica rural en épocas de COVID-19 desde el 2016 hasta el 2021.La estrategia de búsqueda identificó 1480 artículos de bibliotecas digitales como Google Scholar, ACM Digital Library, ProQuest, ARDI, Taylor & Francis Online, Wiley Online Libray y Microsoft Academic y después de filtrar, se consideraron 71 artículos basados en criterios de exclusión. Los resultados de la revisión sistemática se han centrado en estudios recientes de la Telemedicina donde se resalta la importancia en la atención de los pacientes en zonas rurales también proporciona gráficos estadísticos de los estudios extraídos para comparar por relevancia para sus entornos y situaciones(AU)
The COVID-19 pandemic highlighted the importance and utility of telemedicine in providing a way to connect patients and healthcare professionals when an in-person consultation is not possible in rural areas. A systematic review of Telemedicine and its impact on rural healthcare in times of COVID-19 was carried out from 2016 to 2021. The search strategy identified 1480 papers from digital libraries such as Google Scholar, ACM Digital Library, ProQuest, ARDI, Taylor & Francis Online, Wiley Online Libray and Microsoft Academic. Then 71 papers were considered based on exclusion criteria. The results of the systematic review have focused on recent studies of Telemedicine where it highlights the importance in the care of patients in rural areas also provides statistical graphs of the extracted studies to compare by relevance to their settings and situations(AU)
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Rural Areas , Telemedicine , Medical Care , COVID-19 , Unified Health System , Health PersonnelABSTRACT
@#Objective To explore the efficacy of artificial intelligence (AI) detection on pulmonary nodule compared with multidisciplinary team (MDT) in regional medical center. Methods We retrospectively analyzed the clinical data of 102 patients with lung nodules in the Xiamen Fifth Hospital from April to December 2020. There were 57 males and 45 females at age of 36-90 (48.8±11.6) years. The preoperative chest CT was imported into AI system to record the detected lung nodules. The detection rate of pulmonary nodules by AI system was calculated, and the sensitivity, specificity of AI in the different diagnosis of benign and malignant pulmonary was calculated and compared with manual film reading by MDT. Results A total of 322 nodules were detected by AI software system, and 305 nodules were manually detected by physicians (P<0.05). Among them, 113 pulmonary nodules were diagnosed by pathologist. Thirty-eight of 40 lung cancer nodules were AI high-risk nodules, the sensitivity was 95.0%, and 25 of 73 benign nodules were AI high-risk nodules, the specificity was 65.8%. Lung cancer nodules were correctly diagnosed by MDT, but benign nodules were still considered as lung cancer at the first diagnosis in 10 patients. Conclusion AI assisted diagnosis system has strong performance in the detection of pulmonary nodules, but it can not content itself with clinical needs in the differentiation of benign and malignant pulmonary nodules. The artificial intelligence system can be used as an auxiliary tool for MDT to detect pulmonary nodules in regional medical center.
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Objective:To evaluate the operation effect of remote imaging network platform in a regional medical center.Methods:The workload data of remote imaging network in a regional medical center from 2017 to 2019 were analyzed.Results:137 medical institutions were connected to the remote imaging diagnosis network platform, and the number of imaging examinations in grass-roots medical institutions increased significantly. Part of the imaging examination in the superior medical center was gradually diverted to the subordinate medical institutions. However, limited by the ability of image diagnosis, grass-roots medical institutions relied on remote diagnosis of higher-level hospitals.Conclusions:Remote image diagnosis network is an important platform support for Internet plus medical health service, which can rapidly and effectively enhance the ability and level of imaging diagnosis in primary medical institutions.
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Background: The damaging and insidious nature of glaucoma make it spread gradually without being noticed but causes serious harm. In support to this, failure to have adequate knowledge leads to late detection and poses management problem in preventing blindness from glaucoma among glaucoma patients. This study tends to fill such gap by assessing the effect of nurse-led intervention on the self-management of glaucoma among glaucoma patients at Federal Medical Center Idi Aba Abeokuta, Ogun State, Nigeria.Methods: The study utilized one group pre-test, posttest quasi experimental research design with 97 glaucoma patients. Two research instruments were used to collect data. Data were collected over six weeks in three phases. Descriptive statistics were used to analyze the data for the research questions.Results: Mean score of knowledge level of participants on glaucoma increased from 8.13±3.14 (pre intervention) to 15.91±1.68 (post intervention). Pre intervention knowledge mean score level of participants on glaucoma self-management increased from 9.28±3.76 to post intervention mean score of 18.12±1.09; pre intervention skills' mean score of participants on the effective eye drop instillation increased from 4.23±0.88 to 8.47±0.53 at post intervention mean score.Conclusions: The training package enhanced the general knowledge and self-management of glaucoma, as well as skills in eye drop instillation. It is therefore recommended that there is need for nurses to provide clear and detailed instructions on how glaucoma medication must be effectively instilled.
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For provincial children's hospitals and children's hospitals affiliated to medical colleges and universities with a high level of the diagnosis and treatment,they are the center of referral and need to retain pediatricians and build a high-level team of pediatricians.With the authors' own experience in Cincinnati Children's Hospital Medical Center in the US,this article briefly introduces the current clinical operation mode in American children's hospitals,especially the consultation system mainly composed of attending physicians and the mode of continuing medical education based on both clinical and scientific research.Such experience provides a reference for pediatricians in China.
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OBJECTIVE:To introduce training mode of American Pharm. D. project,and to provide reference for pharmacy education mode reform and cultivation of new pharmaceutical talents meeting the needs of pharmaceutical care in the new era in China. METHODS:The training mode,teaching concept,course setting and teaching method of American Pharm. D. project were investigated by observing and learning teaching course of pharmacy practice department in University of Nebraska Medical Center (UNMC). The characteristics of American pharmacy education represented by UNMC were summarized,and the suggestion for pharmacy education reform in China was put forward. RESULTS & CONCLUSIONS:Based on the goal of pharmacy talent cultivation for pharmaceutical care,American pharmacy education confirms and improves training process and course system around the career development goal of pharmacists,pays attention to humanistic concern and pharmacist vocational ability training in teaching mode, focuses on modern teaching technology and diversified teaching methods during teaching course, and implements strict formative evaluation to evaluate teaching effectiveness. Chinese pharmacy education should learn from the successful experience of American Pharm. D. project,confirm the training goal of service-oriented pharmaceutical talents,optimize training procedure and course system of clinical pharmacy major adhere to the goal of vocational development,focus on vocational ability and humanistic care training,actively utilize modern educational technology and diversified teaching methods,gradually combin formative evaluation with summative evaluation,and eventually transfer to the formative evaluation-centered evaluation system,so as to cultivate service-oriented pharmaceutical talents who meet the actual needs of China.
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Resumen Introducción. La publicación científica se debe incentivar desde el pregrado, sobre todo en carreras de ciencias de la salud. Objetivo. Determinar las características y los factores asociados a la publicación científica entre los miembros de la Asociación Científica de Estudiantes de Medicina de Colombia (ASCEMCOL). Materiales y métodos. Se realizó un estudio transversal analítico que se basó en una encuesta presencial aplicada a los miembros de la ASCEMCOL. Se definió como publicación la realizada en una revista científica indexada; la información recolectada se cruzó con variables para obtener estadísticos de asociación. Resultados. Al realizar el análisis multivariado, se asoció a mayor participación en investigaciones científicas el encontrarse en un semestre académico superior (RPa: 1.25; IC95%: 1.01-1.56; p=0.043) y tener más cantidad de investigaciones extracurriculares (RPa: 1.26; IC95%: 1.15-1.38; p<0.001); así mismo, la menor frecuencia de publicación se asoció a la percepción de pobre apoyo por parte de la universidad (RPa: 0.28; IC95%: 0.22-0.34; p<0.001), ajustado por la cantidad de trabajos presentados a congresos y la universidad de procedencia. Conclusión. La frecuencia de publicación fue baja en esta población. Se encontraron factores de gran importancia, como estar en un mayor semestre y tener mayor número de investigaciones realizadas y publicaciones.
Abstract Introduction: The scientific publication should be encouraged from the undergraduates, especially in science health careers. Objective: To determine the features and factors associated with scientific publication among members of the Scientific Association of Medical Students of Colombia (ASCEMCOL). Materials and methods: An analytic cross-sectional study, which was based on a face survey applied to the members of the ASCEMCOL. A publication was defined as a publication made in an indexed scientific journal; and the information collected was crossed with variables to obtain a statistical association. Results: When performing multivariate analysis, it was associated with increased participation in scientific research the fact of being in a superior academic semester (RPA: 1.25; 95% CI: 1.01-1.56; p value: 0.043), more of extracurricular investigations (RPA: 1.26; 95% CI: 1.15-1.38; p value <0.001). Likewise, the lower frequency of publications associated with the perception of poor support from the university (RPA: 0.28; 95% CI: 0.22-0.34; p value <0.001), adjusted to the number of papers presented in congresses and the university of origin. Conclusion: The publication frequency was low in this population; we find important factors like being in a superior academic semester, such as having a greater number of investigations and publications.
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The authors attempted to sort out the training experience of higher education pedagogy in America , and truthfully recorded the understanding and experience of the higher medical elite education of America during visiting the University of Nebraska Medical Center .Combined with the current situation of high medical education in Chi-na, the formation and the embodiment of medical elite education mode of America has also been concretely ana -lyzed , which was expected to bring new enlightenment and reference for the development of high medical elite edu -cation mode and the medical teaching remodeling .
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Thanks to the policies of resources to strengthen grassroots ,and innovative resource placement in Zhejiang province and the help of Zhejiang University School of Medicine ,Shaoxing regional medical center has achieved significant improvement in its medical capabilities .The cooperation features the following :active promotion of new medical ideas and key technologies ;overall enhancement of scientific and technological innovation ;talent training to advance disciplinary development ;and joint efforts to train postgraduates .The momentum ,however ,can only be maintained ,unless such problems as the means of resources placement ,disciplines alignment ,and medical workers development can be well addressed .
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Although in the 5th goal of the millennial development goals it is stated that by within 2015 iscarriages will be reduced by 75% from the year 1990. So far it has been reduced by 34%, only third of its intended goal. Around 358.000 miscarriages happen in a year, which leads to around 1000-1500 miscarriages per day during numerous stages such as: pregnancy, labor, or after birth. Thisproblem has been gathering a lot of attention around the world that it had been added in to the goalsof the millennium development goals. Of the 130 million babies who are born in a year 7.6 millionof them are born with birth defects and 3.2 million die while they are still infants, and 3.6 millioninfants are left handicapped. Of 40-50 million pregnancies that are reported in Asia and the PacificOceania, 30500-50000 women miscarry, and 300000 infants die within the first day since birth. In the Mongolian government’s population development policy, it is stated that the government shall support population growth, to provide a safe living environment for people to live a long prosperous life, and to improve healthcare services for mothers and babies. The total population as of late 2014 is 2 million 995.9 thousand it has risen up by 65.9 thousand since the previous year a 2.2 percent increase. 48.9 percent of the population are males and 51.1 percent are females the ratio of gender is 96:100 for every 100 females there are 96 males. As for age, 28 percent of the population is under 15 years old, 68 percent of the population is between the ages 15-64, 4 percent of the population is 64 years old or older. We have selected this topic because there are no sufficient scientific researchmaterials regarding to pregnancy monitoring despite there are regular reports being made about pregnancy monitoring in accordance to Mongolia’s maternity orders. 135 pregnant women who are routinely monitored at family healthcare centers were selected randomly, the results have been calculated by the SPSS 20 program and statistic information provided by pregnancy monitoring guides, and by a 48 question survey made in accordance by the 338th rule of the pregnancy monitoring of regularly processed women.Of the total 135 pregnant women, 88 (65.2%) have been checked on time. While 47 (34.8%) haven’t been checked on time. Furthermore, of women who are married 72.2 % got checked on time while only a third of the women who weren’t married (33.3%) got checked on time. Marital status was also a key factor in women being on time for regular monitoring (p=0.006). Around 70 percent ofwomen with higher education have shown up on time for regular monitoring whereas only 55 percent of women with secondary education got monitored. Considering the age structure 66.7 percent of women aged 20-24, 82.6 percent of women aged 30-34, 83.3 percent of women aged 35 and higher have been involved in regular checks on time. (p=0.031). Employment has been a factor in checkupattendance. 92.9 percent of women who work at state authorities, 63.6 of women who work in nongovernmentorganizations, 51.6 percent of women who are self-employed, 57.9 percent of students,57.9 percent of unemployed women have participated in checkups on time.(p=0.017).From the women who were surveyed, 57 (41.3%) women who didn’t show up on time for their second examination, by the looks of the women 10(83.3%) who went in monitoring on the second three months into pregnancy were pregnant before. It is clear that the women who were pregnant before lose concern about being monitored.87 (63%) of the women took pregnancy class, of the 51 (37%) who didn’t 13 (15%) took the class because they weren’t able to claim their pregnancy benefits and 35 (68.8%) of the women who didn’t take the pregnancy class have stated that they hadn’t had the time. 16 (31.4%) have claimed that it wasn’t needed. This shows that class attendance is insufficient and people only attend to claim their pregnancy benefits. Because of the lack of special service for pregnant women at district hospitals, women are forced to get service elsewhere. It is clear that local doctors give little advice and information about birth, miscarriage and prevention of misbirth.
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Objective To explore the management mode of regional clinical blood ,as well as the role of Regional Medical Center in the blood management ,and have a comprehensive understanding of Daxing district clinical blood using present situation .Methods Organized Daxing district clinical blood using quality control center experts to do a research of 18 medical institutions in the blood management status of clinical blood demand within the jurisdiction ,and analyzed the statistics related to clinical use of blood in vari‐ous medical institutions from January to December in 2014 ,according to Beijing Wei Yi [2008]189 words in medical institutions of Beijing City ,the department of transfusion(blood bank) in the relevant provisions of the basic standard.Results Through the sur‐vey ,only regional medical center established the department of transfusion in 18 medical institutions ,other medical institutions have set up blood bank .Practitioners of department of transfusion (blood bank) in the number full‐time staff ,with post qualification num‐ber and degree of structure ,difference between regional medical center and other kind hospitals was significant (P0 .05) .Three grade hospitals in biological safety and continuous im‐provement of quality ,could be carried out in accordance with the PDCA cycle ,and have obvious advantages compared with the other one or two grade hospitals .Conclusion Fifteen medical institutions do not have the clinical blood transfusion compatibility testing conditions .To ensure the safety of blood for clinical use ,blood need to be tested by the department of transfusion regional medical center .
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El personal sanitario se enfrenta frecuentemente a situaciones de vida y muerte, por lo que su trabajo puede ser física y emocionalmente agotador. La presencia del síndrome de Burnout representa un riesgo para la salud que afecta la moral y el bienestar psicológico, repercutiendo esto en la calidad y tratamiento que se proporciona al paciente. El objetivo del estudio es determinar la frecuencia del síndrome de Burnout en médicos residentes de especialidades médicas del Hospital Central "Dr. Emilio Cubas" del Instituto de Previsión Social, en el año 2013. El diseño es transeccional descriptivo. La muestra está constituida por 75 residentes de diversos años y especialidades. Se encontró un bajo porcentaje de residentes con este síndrome (6,67%). Si bien, la vida de un médico puede resultar desgastante, la satisfacción profesional que le brinda su trabajo, hace que sea placentera su jornada.
Health workers are often faced with situations of life and death, that is why their work can be physically and emotionally exhausting. The presence of Burnout syndrome represents a health risk that affects the moral and psychological welfare, and this influences the quality and treatment provided to the patient. The aim of the research was to determine the frequency of Burnout syndrome in medical residents medical specialties Hospital Central "Dr. Emilio Cubas' of Instituto de Previsión Social in 2013. The design was descriptive transactional. The sample consisted of 75 residents of different years and specialties. A low percentage of residents with this syndrome (6.67%) was found. Although the life of a doctor can be exhausting, job satisfaction provided by their work make their journey a pleasant one.
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This paper summarized the features of pediatrician training in Cincinnati Children's Hospital Medical Center ( CCHMC ) , introduced their cultivation and appraisal system , compared American pediatrician training with Chinese training and absorbed advanced medical training experi-ences. CCHMC focus on training specialized skill, team spirit and communication ability of residents. Internal assessment and two-way selection help to retain the best fellows. Learning from advanced ex-periences, we hoped to improve the current pediatrician training system and contributed to medical and health services.
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PURPOSE: Home-based care providers were surveyed to assess the effect of collaborative service between Gyeongnam Regional Cancer Center (GRCC) and public health centers (PHCs) in Gyeongnam province. METHODS: Twenty home-based care providers who had previously participated in the GRCC-PHC care project were recruited from nine PHCs and were surveyed using a questionnaire developed by specialists. Questions were rated using the 5-point Likert scale ranging from "strongly disagree (-2)" to "strongly agree (+2)" and each score was multiplied by the corresponding number of respondents (n=20) with the maximum score of 40. RESULTS: Between January 2008 and December 2011, 73 patients were registered to the collaborative service: 72 by GRCC and one by PHC. Home-based care providers marked the highest score (23 points) to "The collaborative service contributed to patients and their family's psychological stability" and the lowest score (11 points) to "The collaborative service was generally helpful for home-based cancer management." For possible suggestions to improve the service, the highest score (35 points) was given to "Simplification of the hospitalization process" followed by "Substantial benefits for patients at their visit to the hospital" (34 points). CONCLUSION: The results revealed several limitations of the GRCC-PHC collaborative care service for terminal cancer patients. The service could be further improved by developing measures to address the limitations and a service model tailored to region-specific needs.