EPIDEMIOCLINICAL PROFILE OF PAIN IN EMERGENCY ROOM OF THE TEACHING HOSPITAL SOUTH MAHAVOKY MAHAJANGA MADAGASCAR

Introduction: Pain is a very frequent symptom in emergency medicine and the understanding of its epidemio-clinical characters is essential to better manage it. The objective of our work was to describe the epidemiological and clinical characteristics of acute pain in a medical emergency department. Materials and methods: This is a prospective study carried out in the Emergency Reception-Triage Service of the CHU-MA Mahajanga, from October 1, 2018 to September 30, 2019. We recorded the socio-demographic data of the patients as well as the characteristics pains. The variables were analyzed by SPSS 25.0 software. The frequency of painful patients admitted is estimated at 43.5%. The Results: pain has concerned mainly patients from 46 to 60 years old (27.33%), with an average age of 57 years of female gender (61.2%). The group working in the informal sector (65.5%) was the most affected. As for the reasons for admission, it was mainly acute pain (86.3%) due to an excess nociception (97.9%), dominated by medical pathologies with preponderance digestive pathologies (34.5%). Through this study, we were able to see that pain is the most common reason for entering the Conclusion: emergency room. According to our study, it predominates in people of age more advanced and the most frequent causes are medical pathologies.

Application of active learning mode based on mind mapping in the teaching of major disaster rescue and medical service support / 中华医学教育探索杂志

Objective:To explore the effect and value of the active learning mode based on mind mapping in the teaching of medical service support for major disasters.Methods:A total of 90 undergraduate students of 2016 Clinical Medicine of Naval Medical University were randomly selected as research objects, and they were randomly divided into observation group and control group. The 45 students in the control group used the traditional teaching mode, and the 45 students in the observation group used the mind mapping-based active learning mode for major disaster rescue and medical survice. The teaching time of the two groups was 12 h. The theoretical examination of knowledge and practical skills of the two groups of students were compared after teaching, and the students' satisfaction with the application of mind mapping-based teaching model in the teaching of medical service support for major disaster rescue was investigated. EmpowerStats and R softwares were used for t test and Chi-square test. Results:There were 24 males and 21 females in the observation group, with an average age of (21.40±0.69) years old. There were 22 males and 23 females, with an average age of (21.71±0.55) years old. The theoretical performance of the observation group (91.38±4.37) was significantly higher than that of the control group (84.91±3.98) ( P<0.001), and the practical skill performance of the observation group (92.98±3.24) was significantly higher than that of the control group (87.38±3.80) ( P<0.001). At the same time, the students' satisfaction with teaching effect in the observation group was 82.2% (37/45), which was significantly higher than that in the control group (37.8%, 17/45). Conclusion:The active learning mode based on mind mapping focuses on cultivating students' independent learning, interactive exploration and clinical thinking ability, and has a broad application prospect in the teaching of medical service support for major disasters.

Analysis on the application of medical force in Shenzhou manned spaceflight missions and enlightenment for medical service support with new regions and new types / 中华急诊医学杂志

Objective:To summarize the practice and experience of medical service support for Shenzhou manned spaceflight mission, and to explore the accurate medical service support strategy with new regions and new types.Methods:A systematic summary was made from the force command, action framework, technical support, and the practice and experience in the application of medical support force for Shenzhou manned flight mission were sorted out.. Furthermore, the key and difficult problems of the new domains with new types of military medical service support were analyzed, and the scheme and significance of establishing the accurate support mode of the new medical service support force were proposed.Results:The Shenzhou emergency rescue mission was an elite combat supported by a large platform. It was an important basis to realize accurate medical service support by the experience of utilizing the medical force of Shenzhou emergency rescue and the strengthening of war-building mode optimization.Conclusions:This paper systematically summarizes the experience and characteristics of medical force application in Shenzhou manned spaceflight missions, and provides new ideas and methods for future diversified and accurate s medical service support with new regions and new types.

Social representations of nurses of the Emergency Care Unit towards people with mental disorder / Representaciones sociales de las enfermeras y enfermeros de la Unidad de Cuidados de Urgencia hacia las personas con trastornos mentales / Representações sociais de enfermeiros da Unidade de Pronto Atendimento às pessoas com transtorno mental

ABSTRACT Objective: To understand the Social Representations of nurses from an Emergency Care Unit about the care provided to people with mental disorders. Method: Qualitative exploratory study, supported by the theoretical and methodological framework of the Theory of Social Representations. Interviews were conducted from July to August 2021. The data were processed using the IRaMuTeQ software. Results: 22 nurses were interviewed. From the processed data, three discursive categories were constructed: the tortuousness of the Psycho-Social Care Network (RAPs): in search of a path; the abyss between the health professional and the person with mental disorder; and unveiling the care of nurses in the Mental Health Emergency Care Unit. Conclusion: We identified a lack of knowledge about the Psychosocial Care Network, anchoring elements associated with previous negative experiences that influence the professional-patient relationship, and nursing care permeated by cognitive barriers. Such findings are unprecedented in the locality studied and relevant to promote the qualification of the work of nurses in mental health in the Emergency Care Unit.

RESUMEN Objetivo: Conocer las Representaciones Sociales de las enfermeras de una Unidad de Cuidados de Urgencia sobre los cuidados prestados a personas con trastornos mentales. Método: Estudio exploratorio cualitativo, apoyado en el marco teórico y metodológico de la Teoría de las Representaciones Sociales. Las entrevistas se realizaron entre julio y agosto de 2021. Los datos se procesaron con el software IraMuTeQ. Resultados: Fueron entrevistadas 22 enfermeras. A partir de los datos procesados, se construyeron tres categorías discursivas: lo tortuoso de la Red de Atención Psicosocial: en busca de un camino; el abismo entre el profesional de la salud y la persona con trastorno mental; y develar el cuidado de las enfermeras en la Unidad de Atención de Emergencias en Salud Mental. Conclusiones: Identificamos un desconocimiento de la Red de Atención Psicosocial, elementos de anclaje asociados a experiencias negativas previas que influyen en la relación profesional-paciente, y cuidados de enfermería permeados por barreras cognitivas. Tales hallazgos son inéditos en la localidad estudiada y relevantes para promover la cualificación del trabajo de enfermería en salud mental en la Unidad de Cuidados de Urgencia.

RESUMO Objetivo: Compreender as Representações Sociais de enfermeiros de uma Unidade de Pronto Atendimento sobre o cuidado dispensado às pessoas com transtornos mentais. Método: Estudo exploratório qualitativo, sustentado pelo referencial teórico-metodológico da Teoria das Representações Sociais. Foram realizadas entrevistas no período de julho a agosto de 2021. Os dados foram processados com o auxílio do software IraMuTeQ. Resultados: Foram entrevistados 22 enfermeiros. A partir dos dados processados foram cosntruídas três categorias discursivas: a tortuosidade da Rede de Atenção Psiscossocial: em busca de um caminho; O abismo entre o profissional de saúde e a pessoa com transtorno mental; e desvelando o cuidado dos enfermeiros da Unidade de Pronto Atendimento em saúde mental. Conclusão Identificou-se falta de conhecimento sobre a Rede de Atenção Psicossocial, elementos de ancoragem associados à experiências prévias negativas que influenciam a relação profissional-paciente e, um cuidado de enfermagem permeado por barreiras cognitivas. Tais achados são inéditos na localidade estudada e relevantes para promover a qualificação do trabalho do enfermeiro em saúde mental na Unidade de Pronto Atendimento.

Analysis on the Integration of Blockchain and the Construction of Harmonious Doctor-patient Relationship in the New Era / 中国医学伦理学

In the era of information technology, the construction of a harmonious doctor-patient relationship is inseparable from the support of information technology. The use of blockchain technology in the medical and health field plays an important role in promoting the construction of a harmonious doctorpatient relationship in the new era. Discuss the organic integration of blockchain technology and the construction of a harmonious doctor-patient relationship in the new era at the three levels of technology, method, and path, and find that the blockchain can provide both technical support and method support for the construction of a harmonious doctor-patient relationship in the new era; Blockchain technology is conducive to promoting the construction of a harmonious doctor-patient relationship in the new era by developing distributed personal lifelong medical accounts, establishing a shared and interactive medical resource service community, and designing a tracking management model for the medical service process.

Analysis on the facilitative factors from willingness to behavior in online medical service / 中华医院管理杂志

Objective:To study the influences of patients′ online medical service from willingness to behavior based on Anderson′s health service utilization model, and to provide reference for improving the utilization rate of internet medical services.Methods:A total of 66 270 patient data were selected from a self built internet medical platform of a tertiary hospital in Zhejiang province in 2021. Indicators such as time of visit, location of visit, doctor′s online activity, doctor′s title, doctor′s age, doctor′s gender, and disease type were subjected to chi-square test and logistic regression analysis to clarify the impact of different indicators on online medical treatment from willingness to behavior.Results:Of the 66 270 people having a willingness to seek online medical treatment, 39 996 people, accounting for 60.35%, achieved online diagnosis and treatment. Online medical services could break through the constraints of time and space and to promote the patient′s seeking medical treatment online from willingness to behavior in a limited way; Doctor′s title had a non-linear effect on patients′ online medical treatment from willingness to behavior; Doctor′s online activeness significantly promoted online medical treatment from willingness to behavior; Female doctors and middle-aged and young doctors promoted online medical treatment from willingness to behavior; Different types of diseases affected online medical treatment in different ways.Conclusions:Among the factors that affect the patient′s transformation from online medical willingness to behavior, the patient′s enabling resources have a facilitative effect, and need factors have a direct impact.

Analysis of medical service units and prices of traditional Chinese medicine in the Yangtze River Delta / 中华医院管理杂志

Objective:To compare and analyze the pricing units and prices of traditional Chinese medicine (TCM) medical services in 4 provinces of the Yangtze River Delta, for reference for the integrated development of TCM medical service project setting and price coordination in the Yangtze River Delta region.Methods:The medical service price project specifications published on the official websites of relevant departments in 4 provinces of the Yangtze River Delta (updated to March 2022) were obtained to extract data such as project names and pricing units. The pricing units and prices of TCM medical service projects in each province were compared and analyzed; The Jevons index method was used to analyze comparable project prices.Results:The numbers of TCM medical service projects in Shanghai, Jiangsu, Zhejiang, and Anhui were 113, 146, 117, and 198, respectively. The types of pricing units were 15, 24, 13, and 12, respectively. There were differences in the setting of pricing units, especially in acupuncture and moxibustion, which had more decomposition projects. The average price of overall medical services in the Yangtze River Delta was 9.81 times that of TCM medical services. There were differences in the prices of comparable TCM medical service projects among the four provinces. Based on Anhui province, the inter provincial Jevons index of other categories of TCM medical service projects except for TCM massage were all less than 1.00.Conclusions:There were significant differences in the pricing units and prices of TCM medical service projects in the four provinces of the Yangtze River Delta, with Anhui province having the most significant difference compared to the other three provinces; The overall price of TCM medical service projects was relatively low.

Experiences and perception of caregivers on home care service for community-dwelling elderly: a qualitative study / 中华全科医师杂志

Objective:To survey the experiences and perception of caregivers on home care service for community-dwelling elderly.Methods:From August to December 2021, individual semi-structured in-depth interviews were conducted with caregivers of the elderly from five community health centers in Beijing Xicheng and Miyun districts selected by purposive sampling.Results:Nine caregivers,2 males and 7 females aged 49-76 (62.8±9.4) years were interviewed in this study. The nursing care period was 3-48 (17±13) years. Four themes were extracted from the interview data: older people′s own condition was the primary factor influencing the home care needs; medical needs for home care were determined by the caregivers′ factors; community health service was important for meet home medical needs; and supporting of home care services for the elderly need to be strengthened.Conclusion:The experience of elderly home caregivers in using community home medical services is affected by many factors, and in the future, the content of home medical services should be improved, and the skills training of community elderly home caregivers should be strengthened, so as to improve the quality of life at home and promote the health literacy of the elderly.

Repercusión de la pandemia por SARS-COV-2 sobre las consultas en los Servicios de Emergencia Pediátrica en Uruguay / Consequences of the SARS-COV-2 pandemic on Pediatric Emergency Services in Uruguay / Repercussão da pandemia de SARS-COV-2 nas consultas nos Serviços de Emergência Pediátrica do Uruguai

En marzo de 2020 se confirma el primer caso de enfermedad por coronavirus en Uruguay, recomendándose un confinamiento social. La atención sanitaria se redujo a servicios de urgencia y emergencia (SE). Objetivo: analizar las características de las consultas pediátricas en los SE del subsector público y privado en Uruguay, durante los primeros 4 meses de la pandemia por SARS-CoV-2. Metodología: estudio descriptivo, retrospectivo, multicéntrico. Resultados: participaron 23 SE de todas las regiones del país. Período 1 prepandemia: 14/03/19-29.07.19, período 2: 14/03/20-29/07/20 Consultas: período 1 n=121.116, período 2 n=33.099 (desciende 73%). Hospitalizaciones desde el SE: período 1 n= .6649 (tasa 5,5%). Período 2: n=2.948 (tasa 9,5%). Diagnósticos período 1: infección respiratoria aguda (IRA) alta 39.892 (33%), IRA baja 86.56 (7%), trauma menor 8.651 (7%), gastroenteritis 8.044 (6,6%), crisis asmática/CBO 7.974 (6,5%), lesiones 4.389 (3,6%), dolor abdominal 3.528 (3%), problemas de salud mental 859 (0,7%), convulsiones 758 (0,7%), patología social 678 (0,5%). Diagnósticos 2020: IRA alta 5.168 (16%), trauma menor 2.759 (8%), lesiones 2.652 (8%), dolor abdominal 1.494 (4,5%), gastroenteritis 1.296 (4%), asma/CBO 1.095 (3,3%), IRA baja 700 (2,1%), patología social 522 (1,6%), problemas de salud mental 471 (1,4%), convulsiones 408 (1,2%). Conclusiones: en los primeros meses de la pandemia hubo una reducción sostenida y significativo de consultas pediátricas en los SE. No hubo aumento en frecuencia absoluta de ninguno de los diagnósticos. Se registró un descenso histórico de las IRA bajas y las hospitalizaciones por esta causa en todo el país. Mantener una vigilancia de las consultas en los SE permitiría identificar e intervenir oportunamente si se produjeran cambios o situaciones de riesgo hasta el momento no detectadas.

In March 2020 the first case of coronavirus disease was confirmed in Uruguay, and lockdown was recommended. Health care services were reduced to Urgency and Emergency Services (ES). Objectives: to analyze the epidemiological characteristics of pediatric visits to the ES of the public and private subsector in Uruguay, during the first 4 months of the SARS-CoV-2 pandemic. Methods: descriptive, retrospective. Results: 23 institutions participated. 2 periods were considered: 1) pre-pandemic, 03/14/19 to 07/29/19, 2) 03/14/20 to 07/29/20. Visits: period 1: n=121,116 (< 15 years), period 2: n=33.099 (73% decrease). Hospital admissions: period 1: n=6,649 (rate 5.5). Period 2: n=2.948 (rate 9,5). Diagnoses period 1: High acute respiratory infection 39,892 (33%), low acute respiratory infection 8,656 (7%), minor trauma 8,651 (7%), gastroenteritis 8,044 (6,6%), asthmatic crisis/CBO 7.974 (6,5%), injuries 4,389 (3,6%), abdominal pain (3,528) 3%, mental health problems 859 (0.7%), seizures 758 (0.7%), social pathology 678 (0.5% ). 2020 diagnoses: high acute respiratory infection 5.168 (16%), minor trauma 2,759 (8%), injuries 2,652 (8%), abdominal pain 1,494 (4.5%), gastroenteritis 1,296 (4%), asthma/CBO 1,095 (3,3%), low acute respiratory infection 700 (2,1%), social pathology 522 (1,6%), mental health problems 471 (1,4%), seizures 408 (1,2%). Conclusions: in the first months of the pandemic there was a sustained and significant reduction in pediatric consultations in ES. There was no increase in absolute frequency of any of the diagnoses. There was a historical decrease in low respiratory infections and hospitalizations due to this cause in the whole country. Maintaining a surveillance of the visits in the ES would enable practitioners to identify and take action in case of changes or previously undetected risk situations.

Em março de 2020, foi confirmado o primeiro caso de doença por coronavírus no Uruguai, recomendando o confinamento. A assistência à saúde foi reduzida a serviços de urgência e emergência (SE). Objetivo: analisar as características das consultas pediátricas no SE do subsetor público e privado no Uruguai, durante os primeiros 4 meses da pandemia de SARS-CoV-2. Metodologia: estudo descritivo, retrospectivo, multicêntrico. Resultados: participaram 23 SEs de todas as regiões do país. Período pré-pandemia 1: 14/03/19-29/07/19, período 2: 14/03/20-29/07/20 Consultas: período 1 n=121.116, período 2 n=33.099 (redução de 73%) . Internações da SE: período 1 n= 0,6649 (taxa 5,5%). Período 2: n=2.948 (taxa de 9,5%). Diagnósticos do período 1: infecção respiratória aguda alta (IRA) 39.892 (33%), LRA baixa 86,56 (7%), trauma menor 8.651 (7%), gastroenterite 8.044 (6,6%), crise asmática/CBO 7.974 (6, 5% ), lesões 4.389 (3,6%), dor abdominal 3.528 (3%), problemas de saúde mental 859 (0,7%), convulsões 758 (0,7%), patologia social 678 (0,5%). Diagnósticos 2020: IRA alta 5.168 (16%), trauma leve 2.759 (8%), lesões 2.652 (8%), dor abdominal 1.494 (4,5%), gastroenterite 1.296 (4%), asma/CBO 1.095 (3, 3%), IRA baixa 700 (2,1%), patologia social 522 (1,6%), problemas de saúde mental 471 (1,4%), convulsões 408 (1,2%). Conclusões: nos primeiros meses da pandemia houve uma redução sustentada e significativa das consultas pediátricas no SE. Não houve aumento na frequência absoluta de nenhum dos diagnósticos. Foi registrado um decréscimo histórico de IRAs baixas e internações por essa causa em todo o país. A manutenção de uma vigilância das consultas no SE permitiria identificar e intervir atempadamente nos casos de alterações ou situações de risco que até agora não tinham sido detectadas.

Assistência de urgência e emergência: desafios no atendimento a múltiplas vítimas / Urgency and emergency assistance: challenges in caring for multiple victims / Urgencias y emergencias: retos en la atención a múltiples víctimas

A urgência e emergência, por sua vez, se faz como ocorrência imprevista com ou sem risco potencial à vida, onde o indivíduo necessita de assistência e pressupõem atendimento rápido, proporcional a sua gravidade. O presente trabalho tem o objetivo de promover reflexões acerca dos desafios que surgem diante do atendimento a múltiplas vítimas nos serviços médicos de urgência e emergência. Trata-se de uma revisão integrativa da literatura. Realizou-se uma análise de materiais já publicados na literatura e artigos científicos divulgados em bases de dados: Scientific Eletronic Library Online, Medical Literature Analysis and Retrieval System Online e Localizador de informação em Saúde. Foram encontradas nas bases de dados, 25 estudos completos, após a leitura dos resumos, 21 artigos foram selecionados para análise na íntegra, sendo 17 eleitos para integrar a revisão integrativa. Diante dos resultados obtidos, observou que as equipes de atendimento pré- hospitalar vivenciam desafios para atender múltiplas vítimas, e dentro desse paradigma existem várias etapas que devem ser seguidas, que envolvem comunicação desde um protocolo de atendimento inicial ao transporte final. Portanto, observa-se a necessidade de maiores estudos e desenvolvimento de novas tecnologias que auxiliam na assistência a múltiplas vítimas, como também o prepara e atualização dos profissionais.

Urgency and emergency, in turn, is made as an unforeseen occurrence with or without potential risk to life, where the individual needs assistance and quick care, in turn, proportional to its severity. The work of emergency care and the need to respond to problems presented in urgent and emergency services. This is an integrative literature review. An analysis was performed of materials already published in the literature and articles published in databases: Scientific Electronic Library Online, Medical Literature Analysis and Retrieval System Online and Health Information Locator. All studies were complete, after reading the studies,21 articles were selected for full analysis, with 17 studies elected to integrate the integrative review. Results obtained, observed that pre care teams experience challenges to support various hospital communication protocols, and within these paradigms from initial care to transport. Therefore, there is a need for studies and development of technologies that assist in the installation of larger and more up-to-date devices, there is a need for studies and development of new technologies, as well as preparation.

La atención de urgencia y emergencia es un suceso imprevisto con o sin riesgo potencial para la vida, en el que el individuo necesita asistencia y requiere una atención rápida, proporcional a su gravedad. Este documento pretende promover la reflexión sobre los retos que surgen al tratar con múltiples víctimas en los servicios médicos de urgencia y emergencia. Se trata de una revisión bibliográfica integradora. Se ha realizado un análisis de los materiales publicados en la literatura y los artículos científicos divulgados en las bases de datos: Scientific Eletronic Library Online, Medical Literature Analysis and Retrieval System Online y Localizador de información en Salud. Se encontraron en las bases de datos, 25 estudios completos, después de leer los resúmenes, se seleccionaron 21 artículos para el análisis en su totalidad, siendo 17 elegidos para integrar la revisión integradora. A partir de los resultados obtenidos, se observa que los equipos de atención prehospitalaria viven desafíos para atender a múltiples víctimas, y dentro de este paradigma existen varias etapas que deben seguirse, que implican la comunicación desde un protocolo de atención inicial hasta el transporte final. Por lo tanto, se observa la necesidad de realizar más estudios y desarrollar nuevas tecnologías que ayuden en la asistencia a las múltiples víctimas, así como la preparación y actualización de los profesionales.

Impact and future of telemedicine amidst the COVID-19 pandemic: a systematic review of the state-of-the-art in Latin America / Impacto e futuro da telemedicina em meio à pandemia de COVID-19: uma revisão sistemática do estado da arte na América Latina

Abstract Significant progress has been made in using information and communication technologies in medicine, by impacting the quality of health-care delivery system and patient care, and paving the way for ground-breaking tools for e-health and clinical decision-support systems. This study investigates the extent to which the evolution of telemedicine applications has been used to support patient care in Latin America (LATAM) amidst the pandemic. Theoretically, the study applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology to identify the impact of telemedicine in the region. Practically, the paper provides a systematic mapping study of the different domain areas and methodological progress in Telemedicine that occurred during the pandemic, and applied a text mining technique to understand the intensities of the terms expressed by the analyzed studies. The results show that while telemedicine has not been extensively used, a greater percentage of the studies report that telemedicine was effective. Approximately 70% positive emotional valence score was found. The paper also provides an empirical discussion and recommendations for the next steps in ample adoption of telemedicine.

Resumo Foram feitos progressos significativos na utilização de tecnologias de informação e comunicação na medicina, com impacto no sistema de prestação de cuidados de saúde e nos cuidados aos doentes, e abrindo caminho a ferramentas inovadoras para sistemas eletrônicos de saúde e de apoio à decisão clínica. O presente estudo investiga até que ponto o crescimento das aplicações da telemedicina tem sido utilizado para apoiar os cuidados aos doentes na América Latina (LATAM) em meio da pandemia. Teoricamente, o estudo aplicou a metodologia Preferred Reporting Items for Systematic Reviews e Meta-Analyses (PRISMA) para identificar o impacto da telemedicina na região. Na prática, o artigo apresenta um estudo de mapeamento sistemático das diferentes áreas de domínio e progresso metodológico em telemedicina que ocorreram durante a pandemia, e aplicou uma técnica de text mining para compreender as intensidades dos termos expressos pelos pesquisas analisadss. Os resultados mostram que, embora a telemedicina não tenha sido amplamente utilizada, um maior percentual de estudos informa que a telemedicina foi eficaz. Foi encontrada uma pontuação de valência emocional positiva de aproximadamente 70%. O documento também traz uma discussão empírica para os próximos passos na adoção da telemedicina.

Pose Testing Method for Medical Service Robots Based on Vision System / 中国医疗器械杂志

Aiming at the medical service robot used in the indoor environment, this study proposes a method to test the pose accuracy of its working surface based on the binocular vision system. This method uses a binocular vision coordinate system to measure targets fixed on the working surface of the service robot, aligns the measurement system with the robot base coordinate system through the nonlinear least squares method, and integrates the multi-eye image data to achieve the accuracy test of the working surface. Finally, the vision test program was tested and verified on a mobile service robot model ABIR X8. According to the accuracy index given in GB/T 38124 Service Robot Performance Test Method, the test results of its pose accuracy were obtained.

Preliminary exploration of medical service price reform based on choice behavior motivation / 中华医院管理杂志

Medical service pricing system is the basic system of health economics, which has a profound impact on physicians′ medical behavior and the running mode of hospital. Rui′an City, Wenzhou City, Zhejiang Province, freed up the cost space of drug and consumables based on the reasonable diagnosis and treatment behavior of doctors and selection of drug and consumables in the hospital procurement link. 68% of the free space was used to improve the price of medical services. 248 medical service items with obvious cost inversion were selected, such as nursing, traditional Chinese medicine, diagnosis, etc., and the price adjustment range was determined according to the agreed free space limit. Meanwhile, the credit mechanism of Alipay was applied to synchronously implement " vacating space and adjusting structure" , so as to solve the game problem between medical treatment and medical insurance, broaden the path of the " translation compensation method" of medical service price reform, and produce policy superposition and linkage effect with the reform of medical insurance payment mode.

Application of quality function deployment technology in extracorporeal membrane oxygenation treatment of patients with critical cardiopulmonary disease / 中华危重病急救医学

Objective:To accurately and effectively identify the most critical needs of extracorporeal membrane oxygenation (ECMO) treatment for patients with severe cardiopulmonary diseases, and to better carry out continuous improvement of medical service quality an patients' satisfaction.Methods:Patients who underwent ECMO and transferred from 56 medical institutions in the Henan Provincial People's Hospital Critical Care Medicine Specialist Alliance [the patients who were transported before applying quality function deployment (QFD) from June 2017 to May 2018 were enrolled as the control group, and patients who were transported after applying QFD from June 2018 to May 2019 were the observation group], medical staff in the alliance hospitals, ECMO transfer teams and transfer driver teams were enrolled as the subjects of the survey. QFD was applied to convert the collected requirements into quality improvement elements for targeted improvement measures.Results:A total of 125 questionnaires were distributed in this survey, and 116 valid questionnaires were collected, including 91 from patients (including 27 from the control group and 64 from the observation group), 10 from the medical staff of the alliance hospitals, 10 from the ECMO transport teams and 5 from the transport driver teams. The questionnaire recovery rate was 92.8%. The improvement elements of ECMO treatment for patients with critical cardiopulmonary diseases were ranked according to the importance, and the top five were as follows: the accuracy of the first diagnosis, the specialization of ECMO team, the guarantee of vehicle safety, the seamless responses, and the smooth coordinated rescue protocol.Conclusion:The top five improvement elements should be prioritized in ECMO treatment of patients with critical cardiopulmonary disease in all hospitals of the Alliance to ensure more accurate and timely treatment.

Characteristics of frequent users of emergency departments living with major neurocognitive disorders: a cohort study / Características dos utilizadores frequentes dos departamentos de emergência que vivem com demência: um estudo de coorte

OBJETIVO: Este estudo teve como objetivo descrever e comparar as características dos adultos idosos, residentes na comunidade, que vivem com demência e que recorreram frequentemente aos departamentos de emergência. METODOLOGIA: Este é um estudo retrospetivo baseado numa análise secundária de dados administrativos provinciais de saúde no Quebeque, Canadá. Incluímos adultos idosos residentes na comunidade do Quebeque considerados utilizadores frequentes dos departamentos de emergência (mínimo de quatro visitas no ano seguinte a uma visita ao departamento de emergência indexada, escolhida aleatoriamente durante o período de 1 de janeiro de 2012 até 31 de dezembro de 2013) e diagnosticados com pelo menos uma condição crônica. Comparamos as características dos utilizadores frequentes que vivem com e sem demência utilizando os testes qui-quadrado e Kruskal-Wallis. RESULTADOS: A coorte do estudo consistiu em 21 393 utilizadores frequentes, dos quais 3051 (14,26%) foram identificados como portadores de demência. Os resultados salientam maior carga de condições crônicas, polifarmácia, uso de antipsicótico e serviços de saúde passados entre esses indivíduos. Os resultados também revelam maior proporção de doenças associadas a síndromes geriátricas como trauma e lesão, desnutrição, hipertensão ortostática e distúrbios de marcha. CONCLUSÃO: Os utilizadores frequentes dos serviços de emergência que vivem com demência representam uma população complexa. Os nossos resultados salientam a importância de abordar sistematicamente as suas necessidades, em contextos apropriados e por meio de intervenções personalizadas. (AU)

OBJECTIVE: This study aimed to describe and compare the characteristics of community-dwelling older adults living with or without major neurocognitive disorders who made frequent use of emergency departments. METHODS: This is a retrospective cohort study based on a secondary analysis of provincial health administrative data in Quebec, Canada. We included community-dwelling older adults from Quebec who were considered frequent emergency department users (a minimum of 4 visits in the year following an index emergency department visit chosen randomly between January 1, 2012, and December 31, 2013) and who had been diagnosed with at least one chronic condition. We compared characteristics of frequent users living with or without major neurocognitive disorders using chi-square and Kruskal-Wallis tests. RESULTS: The study cohort consisted of 21 393 frequent emergency department users, of which 3051 (14.26%) were identified as having a major neurocognitive disorder. The results highlight a higher burden of chronic conditions, polypharmacy, antipsychotic use, and past use of healthcare services among these individuals. The results also reveal a higher proportion of conditions associated with geriatric syndromes such as trauma and injury, malnutrition, orthostatic hypertension, and gait disorders. CONCLUSION: Frequent emergency department users living with major neurocognitive disorders represent a complex population. Our results highlight the importance of systematically addressing their needs in appropriate settings and through customized interventions. (AU)

Medical services for sports injuries and illnesses in the Beijing 2022 Olympic Winter Games / 世界急诊医学杂志（英文）

BACKGROUND: Beijing 2022 Olympic Winter Games was the second Games held amid the COVID-19 pandemic. To a certain extent, it has altered the way sporting activities operate. There is a lack of knowledge on injury risk and illness occurrence in elite winter sport athletes amid the COVID-19 pandemic. This study aimed to describe the incidence of injuries and illnesses sustained during the XXIV Olympic Winter Games in Beijing from February 4 to 20, 2022. METHODS: We recorded the daily number of injuries and illnesses among athletes reported by Beijing 2022 medical staff in the polyclinic, medical venues, and ambulance. We calculated injury and illness incidence as the number of injuries or illnesses occurring during competition or training, respectively, with incidence presented as injuries/illnesses per 100 athlete-days. RESULTS: In total, 2,897 athletes from 91 nations experienced injury or illness. Beijing 2022 medical staff reported 326 injuries and 80 illnesses, equaling 11.3 injuries and 2.8 illnesses per 100 athletes over the 17-day period. Altogether, 11％ of the athletes incurred at least one injury and nearly 3％ incurred at least one illness. The number of injured athletes was highest in the skating sports (n=104), followed by alpine skiing (n=53), ice track (n=37), freestyle skiing (n=36), and ice hockey (n=35), and was the lowest in the Nordic skiing disciplines (n=20). Of the 326 injuries, 14 (4.3％) led to an estimated absence from training or competition of more than 1 week. A total of 52 injured athletes were transferred to hospitals for further care. The number of athletes with illness (n=80) was the highest for skating (n=33) and Nordic skiing (n=22). A total of 50 illnesses (62.5％) were admitted to the department of dentistry/ophthalmology/otolaryngology, and the most common cause of illness was other causes, including preexisting illness and medicine (n=52, 65％). CONCLUSION: Overall, 11％ of athletes incurred at least one injury during the Games, which is similar to the findings during the Olympic Winter Games in 2014 and 2018. Regarding illness, 2％ of athletes were affected, which is approximately one-third of the number affected in the 2018 Olympic Winter Games.

Effect of the general reform on county-level hospitals′ financial performance: a case study / 中华医院管理杂志

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.

Analysis of patients′preferences for medical treatment on an online medical platform from 2016 to 2020 / 中华医院管理杂志

Objective:To understand the preference of patients for online medical services, so as to improve the development of internet-based healthcare.Methods:The data came from the online medical cases and online medical orders of the Hao Daifu online platform from 2016 to 2020. The reasons for medical treatment, disease severity, consultation type, time of medical service, patient′s region, and the price of medical services were covered in such an analysis. Data were analyzed descriptively, and chi-square test or t-test was used for comparison between groups.Results:This study covered 41.228 6 million online medical cases and 26.683 2 million online medical orders. The diseases receiving online medical services were mainly common ones, and the distribution of disease severity in different years was statistically different( P<0.001); There was a significant difference in the distribution of inquiry forms of online medical orders in different years( P<0.001); Online medical service time was concentrated from 8: 00 to 22: 00 every day; The number of online medical visits per 10 000 population in the eastern region was significantly higher than that in the central and western regions( P<0.05); The price range of online medical treatment was concentrated in 1-100 yuan. Conclusions:In China, the types of online medical services were mainly common ones, and the medical service time and price range were relatively stable. The number of online medical services in the eastern region is higher than that in the central and western regions. In the future, the online medical platforms are expected to focus on online services for chronic diseases, improve the responsiveness of such services, establish a scientific doctor scheduling system, narrow the regional digital divide of such services, and optimize their rational pricing.

Investigation on the chronic disease management of hypertension in county-level medical institutions in China / 中华医院管理杂志

Objective:To investigate the development of hypertension specialty and chronic disease management of county-level hospitals in China, for reference in improving the standardized chronic disease management level of hypertension in the counties.Methods:From September to November 2020, a questionnaire survey on 597 county-level hospitals in 24 provinces was conducted on a voluntary basis. The survey covered such areas as the setup of hypertension specialty, team building of professionals and the management regulations of chronic hypertension of the hospital. The survey data were analyzed by descriptive statistics.Results:Among the 597 county-level hospitals, 54(13.5%) hospitals had independent hypertension departments, 147(24.6%) had hypertension clinics, and 143(24.0%) hospitals had hypertension beds. 431(72.2%) hospitals had hypertension diagnosis and treatment process in outpatient clinics, 454(76.0%) hospitals had hypertension diagnosis and treatment process in wards, and 535(89.6%) hospitals had graded diagnosis and treatment process of hypertension. 473(79.2%) hospitals had established county medical alliance as the lead unit, including 167 compact medical alliances. 97.7% of the hospitals were equipped with basic hypertension risk stratification screening items, and 63.8% could carry out primary screening of secondary hypertension.Conclusions:The pattern of chronic diseases management of hypertension in county-level medical institutions has basically taken shape, but there is still room for improvement. In the future, we should focus on the construction of professional teams of hypertension, the standardized management of diagnosis and treatment of hypertension, and a smoother path of tiered medical service, so as to increase the health management level of hypertension in China.