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Day surgery can effectively improve the utilization of medical resources. In October 2015, an obstetrics and gynecology hospital established a gynecological day surgery center to centrally manage gynecological day surgery and continuously optimize the management process. In July 2019, the hospital established an intelligent information platform for gynecological daytime surgery managemen. Based on this platform, the " evaluation-appointment-hospitalization-follow-up-chronic disease management" information management process was implemented, the " pre hospital-in hospital-post hospital" full process medical quality and safety monitoring was carried out to form a centralized closed-loop management mode for gynecological day surgery led by gynecologists. Under this management mode, the number of gynecological day surgeries in the hospital has increased from 2 866 cases in 2019 to 4 065 cases in 2021, providing convenient medical services and personalized chronic disease management services, and ensuring the quality and safety of gynecological day medical care, for reference for promoting the high-quality development of day surgeries in specialized hospitals.
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Objective:To investigate the effects of Manchester Pain Management Model (MPMM) on postoperative pain and joint function for patients undergoing rotator cuff repair surgery.Methods:A total of 66 patients undergoing rotator cuff repair surgery from February 2017 to October 2020 in the First People′s Hospital of Hefei were divided into experimental group and control group by random digits table method, with 33 cases in each group. The control group received routine nursing; based on the routine care, the experimental group implemented MPMM-based intervention. The degree of pain and shoulder function of the two groups were assessed by Visual Analogue Scale (VAS) and Constant-Murley Scale (CMS).Results:During the study period, 1 case in the experimental group was lost, 32 cases in the final experimental group and 33 cases in the control group. There was no significant difference in the score of VAS and CMS before surgery between the two groups ( P>0.05). At 1 day, 3 days, 3 weeks and 6 weeks after surgery, VAS scores in the experimental group were 5.47 ± 1.72, 4.63 ± 1.16, 3.25 ± 0.78, 1.81 ± 0.52, lower than those scores in the control group 6.42 ± 1.03, 5.45 ± 1.54, 4.30 ± 0.64, 2.39 ± 0.47, the differences were statistically significant ( t values were 2.36-3.11, all P<0.05). At 3, 6, 12 weeks after surgery, CMS scores in the experimental group were 57.09 ± 4.32, 67.75 ± 4.60, 81.94 ± 4.18, higher than those scores in the control group 52.27 ± 5.39, 64.24 ± 3.76, 78.91 ± 4.36, the differences were statistically significant ( t=3.97, 3.37, 2.89, all P<0.01). Conclusions:MPMM can effectively alleviate the postoperative pain and promote the recovery of joint function in patients undergoing rotator cuff repair surgery.
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Objective:To solve the dilemma between the traditional ethics review management model and the fast development of biomedical research involving human subject, and to effectively summarize the practical experience to improve the efficiency of ethics review.Methods:A series of measures, such as reorganizing the ethics committee, adjusting the operating procedures of the office and optimizing the process of joint review were reviewed and summarized. The successful experience of relevant measures is systematically shared in practice.Results:The practice proved that these measures effectively guaranteed the fast development of clinical trials and research in our hospital during the past two years.Conclusions:The author hopes to strengthen the discussion and exchange with professionals in the industry through the successful practical experience of our hospital, and contribute to the improvement of the level of ethical management in China.
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China’s chronic disease management suffers from problems such as unclear institutional function， insufficient information technology application， and weak regulation support. On the basis of current chronic disease management condition in China， this paper proposes to apply the concept of “people-centered” integrated health management to community chronic disease management and discusses the content and procedure of establishing an integrated community-based chronic disease management model driven by massive databases. The model innovatively combines technology integration， data integration and service integration， and can accurately and efficiently realize the "people-centered" full-course health management of various chronic diseases. Shanghai has provided integrated community-based chronic disease management service for 1.98 million citizens through applying this model. The model warrants further effectiveness and economic evaluation. This study provides precious experience for the development of chronic disease prevention and treatment in China.
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RESUMO Com o crescimento da população urbana e consequente alteração do uso e da ocupação do solo nas bacias hidrográficas, as inundações têm ficado cada vez mais frequentes. O presente trabalho teve como objetivo verificar os efeitos do emprego de técnicas compensatórias na sub-bacia hidrográfica Ribeirão do Santa Rita, localizada no município de Fernandópolis, São Paulo, Brasil. Foram analisados a vazão de pico e o tempo de resposta de diversos cenários, com o intuito de verificar o potencial de atenuação das inundações. A metodologia utilizada empregou o Storm Water Management Model (SWMM) para propagar o escoamento, e o software de Sistema de Informação Geográfica (SIG) para obter as características da bacia em estudo e os locais de potencial emprego das técnicas. Foi simulada a instalação de diversas técnicas compensatórias, isoladamente e em conjunto, para a configuração urbana de 2017. Mediante os hidrogramas gerados por cada cenário, constatou-se que os melhores resultados ocorreram em eventos com tempo de retorno menor. A atenuação da vazão de pico chegou a 33,72% utilizando-se trincheiras de infiltração, 31,38% para pavimentos permeáveis, 31,08% empregando jardins de chuva e 12,20% com telhados verdes. O aumento no tempo de resposta foi de até 16 minutos. No cenário com todas as técnicas compensatórias, a redução foi de até 37,29% da vazão de pico e o aumento do tempo de resposta foi de 18 minutos. Portanto, as técnicas compensatórias podem reduzir a vazão de pico e aumentar o tempo de resposta da sub-bacia, mitigando as ocorrências de inundações.
ABSTRACT With the growth of the urban population and the consequent alteration of land use and occupation in the watersheds, floods have become more frequent. This paper aimed to verify the effects of the use of compensatory techniques in the watershed Ribeirão do Santa Rita, located in the city of Fernandópolis, São Paulo, Brazil. Peak flow and response time of various scenarios were analyzed in order to verify the potential for flood mitigation. The methodology used Storm Water Management Model (SWMM) to propagate the flow, with the support of the Geographic Information Systems (GIS) to obtain the characteristics of the studied watersheed and the places of potential use of the techniques. The installation of several compensatory techniques was simulated, separately and together, for the 2017 urban configuration. Upon the hydrographs generated by each scenario, it was found that the best results occurred in events with shorter return time. Peak flow attenuation reached 33.72% using infiltration trenches, 31.38% for pours pavements, 31.08% using rain gardens, and 12.20% with green roofs. The increase in lag time was up to 16 minutes. In the scenario with all compensatory techniques, the reduction in peak flow was up to 37.29% and the response time increased by 18 minutes. Therefore, compensatory techniques can reduce peak flow and increase the response time of the sub-basin, consequently mitigating the occurrences of floods.
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To enhance primary and secondary stroke prevention, the Stroke Prevention and Control Project committee of the National Health Commission launched since October 2017 a nationwide training program for cerebrocardiac health advisors in the country. The authors introduced the standardized training system for such advisors, and the health management plan for stroke patients, in an effort to provide full-course health management scheme for stroke patients, and explore a stroke management model led by cerebrocardiac health advisors. Such efforts were designed to promote effective implementation of integrated prevention and control strategies for stroke, and provide a reference for the clinical practice of cerebrocardiac health advisors in a comprehensive and in-depth manner.
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Objective:To examine the relationship between conflict management model, perceived social support and psychological distress in psychiatric nurses, and to analyze the mediating effect of conflict management model in the relationship between perceived social support and psychological distress in psychiatric nurses.Methods:In November 2019, a total of 208 nurses in Shandong Mental Health Center were investigated with General Demography Questionnaire, Nurses' Interpersonal Conflict Handling Form Scale, Kessler Psychological Distress Scale and Perceived Social Support Scale.Results:The total score of psychological distress of psychiatric nurses was 22.74±7.71, and the level of psychological distress was negatively correlated with the integrated conflict management model and perceived social support ( r values were -0.329--0.266, P<0.001). The most commonly used conflict management model of psychiatric nurses was "integration". The integrated conflict management model had a partial mediating effect in perceived social support and psychological distress, and the mediating effect accounted for 20.2% of the total effect. Conclusions:Psychological distress of psychiatric nurses is at a moderate to severe level, and integrated conflict management model and perceived social support play an important role in reducing psychological distress of psychiatric nurses. Nursing administrators should carry out relevant intervention studies to improve nurse-patient conflict and guide nurses to adopt integrated conflict management model to reduce psychological distress and improve mental health level.
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Objective:To explore the effect of nurse-led management model in adherence of patients with obstructive sleep apnea hypopnea syndrome (OSAHS) who underwent non-invasive mechanical ventilation.Methods:92 patients with severe OSAHS diagnosed by polysomnography(PSG) and treated with non-invasive mechanical ventilation in Tianjin medical university general hospital from September 2019 to August 2020 were enrolled. The patients were divided into intervention group (45 cases) and control group (47 cases) by random number table. Then, basing on routine treatment and subsequent visit, the patients in intervention group received regular telephone follow-up interviews within one week of ventilator purchasing, and the interview was based on a standard telephone follow-up manuscript designed by Duffy and lasted for six months. The patients in control group received routine nursing treatment and regular subsequent visit, and were not followed up by telephone, but were encouraged to have telephone consultation. The Epworth sleepiness scale(ESS) scores of the two groups before and after the intervention and the compliance of non-invasive mechanical ventilation of the two groups after the intervention were compared.Results:After the intervention, the ESS scores of the two groups were lower than those before the intervention ( P<0.001), and the ESS scores of the intervention group were lower than those of the control group ( P<0.001). After the intervention, the compliance of noninvasive mechanical ventilation in the intervention group was better than that in the control group ( P<0.001). Conclusions:The nurse-led management model in combination with telephone follow-up can improve the sleepiness of patients and the adherence of using non-invasive mechanical.
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Objective:To explore the application of integrated medical-nursing management model for clinical nursing teaching in neonatology department.Methods:A total of 28 undergraduate nursing students having internship in neonatology department from August 2018 to February 2020 were enrolled in the study, among which 15 nursing students from August 2018 to May 2019 were selected as the control group, and 13 nursing students from August 2019 to February 2020 were selected as the observation group. The control group was given traditional teaching, and the observation group was given integrated teaching of medical care. The theoretical scores, nursing operation, comprehensive quality, total scores and teaching satisfaction of the two groups were compared. SPSS 19.0 was used for t test. Results:The theoretical scores of the observation group and the control group were (96.31±0.85) points and (88.47±1.92) points, respectively. Nursing operation scores of observation group and control group were (95.18±2.06) points and (93.15±2.13) points. Comprehensive quality of observation group and control group were (96.23±1.48) points and (90.47±1.88) points. The total scores of the observation group and the control group were (96.83±1.27) points and (91.20±1.31) points, respectively. All the differences were statistically significant ( P<0.05). Ther were significant differences between the two groups in terms of teaching satisfaction including teaching methods, contents, teachers' satisfaction and total satisfaction( P<0.05). Conclusion:In the clinical nursing teaching of neonatology department, the integrated medical-nursing management model is helpful to improve the clinical comprehensive quality and teaching satisfaction of undergraduate nursing students.
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Based on the GAPS(goal, analyze, problem, solution) management model, the authors analyzed the problems existing in the practice of prescription audit and the strategies of continuous optimization. Multi-disciplinary team(MDT) and evidence-based practice were applied to help the continuous optimization of prescription audit practice and promote the rational drug use management of medical institutions. Through the establishment of accurate control process, the personalized management of prescription dosage of chronic diseases, perioperative drugs, special grade antibiotics and auxiliary drugs was realized. The practice of prescription audit based on the GAPS management model, on the one hand, could improve the quality and efficiency of prescription audit, gradually improve the qualified rate of prescription, strengthen clinical use intervention and promote rational drug use; On the other hand, it could reflect the value of pharmacists′ professional technicians, provide patients with more high-quality pharmaceutical care, and gradually realize the prescription audit mode of " improving quality, controlling cost and increasing efficiency" .
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RESUMO A remoção da cobertura vegetal e a impermeabilização de grandes áreas somadas à ineficiência dos serviços básicos de saneamento, contribuem para o aumento das cargas poluidoras pontuais e difusas que são transportadas superficialmente pelas águas pluviais, causando impactos negativos ao sistema de drenagem. Como o despejo ilegal de efluentes domésticos em redes de drenagem é uma realidade observada em todo o país, principalmente no meio urbano, hoje, a maior preocupação dos gestores e estudiosos é voltada às fontes pontuais de poluição e, apesar da importância, as fontes difusas têm recebido pouca atenção. Este trabalho objetivou modelar, utilizando o programa Storm Water Management Model (SWMM), a qualidade das águas pluviais a partir da avaliação do acúmulo de poluentes na superfície do solo em períodos secos e da lavagem durante eventos de precipitação na Bacia Hidrográfica Riacho do Prado, inserida no perímetro urbano da cidade de Campina Grande, Paraíba. Oito pontos no canal de drenagem foram monitorados, analisando-se as variáveis demanda bioquímica de oxigênio (DBO), demanda química de oxigênio (DQO) e fósforo total (FT), além da determinação da vazão. Os resultados obtidos nas simulações do comportamento dos poluentes em escala temporal para o evento medido do dia 08 de junho de 2018 foram condizentes com os valores observados nas análises laboratoriais, confirmando a eficiência dos resultados para as outras simulações realizadas. Os dias antecedentes sem chuva e a intensidade da precipitação se mostraram importantes na análise da carga poluente.
ABSTRACT Removal of vegetation cover and the expansion of impermeable land, together with the inefficiency of basic sanitation services, contribute to the increase of point and diffuse pollutant loads drained by rainwater, causing negative impacts at drainage system. As the illegal discharging of domestic sewage in drainage canals is a reality observed throughout the country, especially in urban areas, today the main concern of managers and researchers is directed to the point sources of pollution and, despite the importance, diffuse sources have received little attention. This work aims to model the rainwater quality using the Storm Water Management Model (SWMM) from the evaluation of buildup pollutants on the soil surface in dry periods and the washoff during precipitation events in the Riacho do Prado watershed located in the urban area of Campina Grande, Paraíba. Eight points were monitored at the drainage canal, in which the variables BOD5, COD, and total phosphorus were analyzed, in addition to flow determination. The results obtained on the simulations of behavior of pollutants in time scale for the actual event of 06/08/2018 were in agreement with the values observed at laboratory analyses, confirming the efficiency of results for the other simulations. The previous days without rain and the intensity of precipitation were important in the analysis of the pollutant load.
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Resumen Se muestran los resultados del diseño y validación de un Modelo de Gestión de Capital Intelectual (CI) para la calidad de IES, Colombia 2014-2016. Investigación aplicada, de carácter mixta. El abordaje cualitativo fue a partir de la confrontación de la teoría con las condiciones específicas del objeto abordado (sus características y necesidades) lo que permitió el diseño del modelo. El abordaje de los datos cuantitativos fue estadístico. Se diseñaron siete encuestas las cuales fueron validadas por expertos. Fue denominado Modelo Sistémico-Dinámico de Gestión del Capital Intelectual para la Calidad de Instituciones de Educación Superior (SIDIGCIES), su diseño estuvo fundamentado en tres teorías: la Teoría de las Organizaciones Inteligentes de Senge, la Teoría de las Capacidades Dinámicas en el Mundo Empresarial de Teece, Pisano y Shuen, y la Teoría de Creación del Conocimiento de Nonaka y Takeuchi. También se tuvieron en cuenta los lineamientos del Consejo Nacional de Acreditación (CNA) de Colombia tanto para programas como instituciones. Está estructurado por cuatro Subsistemas - Dinámicos: Talento Humano, Investigación e Innovación, Académico Administrativo y Reconocimiento Social. La validación del modelo en un programa de Medicina mostró la pertinencia de SIDIGCIES, con las exigencias establecidas a nivel nacional e internacional para la acreditación de programas y de instituciones. Se logró el diseño de 92 indicadores para la medición distribuidos en cada uno de los subsistemas y de siete instrumentos para cada uno de los actores del proceso de enseñanza-aprendizaje debidamente validados, contando de esta manera con herramientas fiables de medición de la gestión del capital intelectual.
Abstract The results of the design and validation of an Intellectual Capital (CI) management model for the quality of IES, Colombia 2014-2016 are shown. Applied research, mixed-nature. The qualitative approach was from the confrontation of the theory with the specific conditions of the object addressed (its characteristics and needs) which allowed the design of the model. The quantitative data approach was statistical. The population corresponds to the educational actors (teachers, students, administrative and management) of the medicine program, a total of 2139. The sampling was stratified and to determine the size of each of the stratum, took into account the population variances of the same and opted to use the criterion of Neyman's Affixation. For data analysis, they were presented in frequency distribution tables, with range and confidence interval measurements at 95 % (CI-95 %). Also, to observe the relationship between the variables (aspects) and the actors, a simple correspondence analysis was performed. All information was processed in the R-CRAN program. Seven surveys were designed which were validated by experts in higher education, who qualified coherence with the objectives of the study, the shape of the instrument and the clarity of the questions. The analysis of theories on intellectual capital allowed the design of the systemic-dynamic model of management of intellectual capital for the quality of institutions of higher education-SIDIGCIES, is based on three theories: Theory of dynamic capacities in the business world, of Teece, Pisano and Shuen; And, Theory of knowledge creation of Nonaka and Takeuchi. The guidelines of the National Accreditation Council (CNA) of Colombia were also taken into account for both programs and institutions. It is structured by four dynamic subsystems: human talent, research and innovation, academic administration and Social recognition. Its name is due to the way the management of intellectual capital in the IES must work, which requires an interconnected system, whose relationship is developed in a dynamic and non-static way when it is constantly moving, constantly improving and Adjustments, in constant internal interaction in each one of its elements and with the external medium. It is precisely the continuous interaction between the members of the Organization and other external agents in a careful way, which leads to the creation of new knowledge. Around the dynamic subsystems the elements that make possible the promotion and distribution of knowledge are undulating, they are: tacit knowledge, explicit knowledge, organizational knowledge and inter-organizational knowledge. In turn, the dynamic subsystems are influenced by four elements that directly affect their integral behavior and the achievement of the objectives of the IES. Without them, is not possible effective management of intellectual Capital; these are: Financial condition, national and international context, ethical-Legal aspects and physical infrastructure and material resources. The validation of the model in a medical program showed the relevance of SIDIGCIES, with the national and international requirements established for the accreditation of programs and institutions. We achieved the design of 92 indicators for measurement, distributed in each of the subsystems with this is possible a comprehensive analysis of their reality and not fractionally. Seven instruments were also designed for the actors of the teaching-learning process duly validated, counting in this way with reliable tools of measurement of the management of the CI SIDIGCIES, that allows the systematic and interdisciplinary study, oriented to identify the intellectual resources to share, employ, keep and protect them at the individual, organizational, social and global levels. It is a tool that will orient the proper management of the CI, will motivate the recognition of the value of the human talent for the production of the intangibles that there are produced, towards the recognition of the quality by the society and the State.
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RESUMO Os sistemas de drenagem urbana podem representar fontes de aporte de poluentes aos corpos receptores aos quais se destinam. Diante disso, o presente trabalho teve como objetivo propor uma ferramenta para modelagem do sistema de drenagem urbana da bacia da Vertente Marítima de Fortaleza, Ceará, visando à avaliação das cargas bacteriológicas. Para esse fim, foi selecionado o stormwater management model (SWMM) para as simulações hidrológicas e hidráulicas; propôs-se uma metodologia para o cálculo das cargas bacteriológicas por meio da estimativa da carga difusa [CD] (NMP. dia-1.ha-1) e para a correlação desta com uma série de variáveis hidroambientais; e analisaram-se cenários para diferentes condições de precipitação pluviométrica, coleta de esgoto e resíduos sólidos dispostos inadequadamente (RSDI). Os resultados mostraram que o SWMM oferece respostas representativas e que o período chuvoso é responsável pelo maior aporte da carga bacteriológica à orla. Em relação ao modelo preditivo, foi ajustada uma função de potência de segunda ordem correlacionando CD com a precipitação média mensal (mm.dia-1) para as três sub-bacias analisadas. Posteriormente, os coeficientes das equações encontradas foram correlacionados ao indicador RSDI (kg.dia-1), obtendo-se um ajuste logarítmico (R2 = 0,99), com o qual é possível gerar uma equação de estimativa de CD para qualquer sub-bacia da Vertente Marítima. A análise dos cenários mostrou haver aumento significativo da carga em precipitações extremas (2 vezes) e diminuição considerável com a elevação da fração da população interligada à rede de esgoto, bem como diminuição da produção de RSDI (0,28 e 0,38 vezes do valor inicial nos Riachos Jacarecanga e Maceió, respectivamente).
ABSTRACT Urban drainage systems can represent sources of pollutants input to the receiving bodies for which they are intended. Therefore, the present work aims to propose a tool for modeling the urban drainage system of the Vertente Marítima basin of Fortaleza, Ceará, aiming at the evaluation of bacteriological loads. For this purpose, the Stormwater Management Model (SWMM) was selected for the hydrological and hydraulic simulations; a methodology for the calculation of bacteriological loads was proposed by estimating the diffuse load [DL] (MPN, day-1.ha-1) and its correlation with a series of hydro-environmental variables and scenarios for different pluviometry precipitation conditions were analyzed, as well as sewage collection and inadequately disposed solid waste (IDSW). The results show that SWMM gives representative results and that the rainy season is responsible for the greater contribution of the bacteriological load to the seafront. Regarding the predictive model, a second-order potential function was adjusted by correlating DL with the average monthly precipitation (mm.day-1) for the three sub-basins analyzed. Subsequently, the coefficients of the equations found were correlated to IDSW (kg.day-1), obtaining a logarithmic adjustment (R2 = 0.99), with which it is possible to obtain a DL estimation equation for any sub-basin of Vertente Marítima. An analysis of the scenarios showed a significant increase of the load in extreme precipitations (twice) and a considerable decrease with the increase of the fraction of the population connected to the sewage network and the decrease of IDSW production (0.28 and 0.38 times the initial value in the Jacarecanga and Maceió Stream, respectively).
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By analyzing the main problems existing in the current management of medical devices for clinical trials, this study proposes a feasible management model and specific requirements for acceptance, distribution, storage and recovery combining with the characteristics of medical consumable equipment and diagnostic reagent, which provides a favorable guarantee for the authenticity and reliability of clinical trials.
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Clinical Trials as Topic , Equipment and Supplies/standards , Indicators and Reagents/standards , Reproducibility of Results , Research Design/standardsABSTRACT
Resumo: O objetivo do artigo é apresentar como o modelo de gestão dos serviços do SUS por organização social se apresenta nos Planos Estaduais Plurianuais de Saúde nos quadriênios de 2012-5 e 2016-9, de onze estados brasileiros. A pesquisa evidenciou que poucos planos fazem referências explícitas aos serviços com gestão por organização social, mas a maioria dos estados propõe a adoção da gestão dos serviços por meio de organizações sociais ou estratégias que se vinculam à parceria público-privado.
Abstract: The goal of the article is to present how the model of management of SUS's services by Social Organization are presented in the Health Multiannual State Plans in the quadrennias of 2012-5 and 2016-9, from eleven Brazilian states. The research evidenced that few Plans have explicit references to services with management by Social Organization, but most of the States propose the adoption of the management of the services through Social Organizations or strategies that are linked to the public-private partnership.
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La rehabilitación minera es uno de los mecanismos implementados para equilibrar la degradación en las áreas minadas y en varios países son descritos como importantes instrumentos en las políticas públicas. Su objeto es asegurar la corrección de los impactos ambientales negativos y de grandes envergaduras, dándole un uso final a los terrenos rehabilitados. La actividad minera de níquel es uno de los sectores más importantes de la economía nacional cubana, dado el nivel de aportaciones que genera al Producto Interno Bruto. Esta actividad, por su naturaleza, tiende a ser no sustentable pues impacta devastadoramente los ecosistemas ubicados en el yacimiento. Es por ello que existe una necesidad inmediata de proponer una solución desde las diferentes ciencias, fundamentalmente las ciencias económicas. El presente trabajo tiene como objetivo incorporar las dimensiones económicas, ambientales y sociales en el proceso de rehabilitación minera, a través de la concepción de un modelo de gestión que contribuya al logro del desarrollo sustentable. Se realiza un análisis documental de bibliografía científico-técnica especializada, el cual refleja los problemas ambientales que afectan al municipio de Moa por el desarrollo de la minería de níquel. Como resultado se propone un modelo de gestión medioambiental para la rehabilitación minera que permita aprovechar adecuadamente el escenario afectado por este tipo de actividad en aras de disminuir la afectación de los ecosistemas y elevar la calidad de vida de los pobladores.
Mining rehabilitation is one of the mechanisms implemented to balance degradation in mined areas and it is described in several countries as an important instrument in public policies. Its purpose is to ensure the correction of negative and large scale environmental impacts, giving a final use to the rehabilitated land. Nickel mining activity is one of the most important sectors of the Cuban national economy, due to the level of contributions that it generates to Gross Domestic Product. This activity, because of its nature, tends to be unsustainable because it devastates the ecosystems located in the deposit. That is why there is an immediate need to propose a solution from the different sciences, specifically from the Economic Sciences. The objective of this paper is to incorporate the economic, environmental and social dimensions in the mining rehabilitation process through the conception of a management model that contributes to the achievement of sustainable development. A documentary analysis of specialized scientific and technical literature was carried out which reflects the environmental problems that affect the Municipality of Moa due to the strip mining of nickel. As a result, an environmental management model for mining rehabilitation is proposed that allows taking adequate advantage of the scenario affected by this type of activity in order to reduce the impact of ecosystems and increase the quality of life of the inhabitants.
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Humans , Mining , Ecosystem , Environmental Management , Environmental EconomicsABSTRACT
Objective To evaluate practical effects of self-management model among HIV-infected men who have sex with men (MSM), and to provide evidence for the development of HIV/AIDS comprehensive management strategies for this population. Methods Respondent-driven sampling (RDS) sampling was used to recruit subjects with the help of the non-governmental organization. Selected MSM were randomly divided into intervention group and control group. The intervention group implemented a self-management model and established a self-management group to conduct health education courses and peer-education based on chronic disease self-management (CDSM) theory. The control group was organized by the center for diseases control and prevention (CDC ) to carry out medical follow-up and other related activities. After one year, the evaluation survey was carried out, and the data was statistically analyzed using SPSS software. Results The CDSM team had different degrees of improvement in the scores of general health, role function,quality life,health transition and mental health sumonary scores. The proportion of self-management groups with anxiety symptoms decreased from 38.6% to 22.6%, the proportion of condom use increased from 43.3% to 47.3%, and the proportion of adherence to medication increased from 68.2% to 78.8%. Conclusion The self-management model can effectively break through the bottleneck of HIV/AIDS management for MSM and can improve quality of life of them.
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Objective@#To explore the effect of "diabetes specialists-community general practitioners-community nurse co-management mode" and "diabetes specialist management mode" on diabetic nephropathy (DN) in primary medical institutions.@*Methods@#Patients with type 2 diabetes admitted to Quanzijie Health Clinic of Jimusar County of Xinjiang Uygur Autonomous Region from October 2017 to March 2018 were enrolled. The Patients were divided into co-management group or specialist management group according to their administrative villages. The treatment plans of the two groups were formulated with reference to the current guidelines. The subjects of the co-management group were jointly managed by a fixed team composed of diabetes specialists from Jimusar Traditional Chinese Medicine Hospital, community general practitioners and community nurses from Quanzijie Health Clinic, and required to attend diabetes education courses every month. The diabetes specialist of Jimusar Traditional Chinese Medicine Hospital was responsible for the formulation and management of the treatment plan of the research object. Follow-up was fulfilled once every 4 weeks for 24 weeks in two groups. Before and after intervention, blood glucose, blood pressure, urinary albumin/creatinine ratio (UACR), estimated glomerular filtration rate (eGFR) as well as the utilization rate of angiotensin converting enzyme inhibitors/angiotensin Ⅱ receptor blocker (ACEI/ARB) were collected.@*Results@#A total of 115 patients accomplished this study with 54 patients in co-management group and 61 patients in specialist management group. After 24 weeks of intervention, fasting glucose level, postprandial glucose level 2 hours after breakfast, glycosylated hemoglobin (HbA1c), Log UACR in co-management group and specialists management group were significantly decreased compared with baseline [fasting glucose level (mmol/L): 8.06±1.92 vs. 9.16±2.83, 8.21±2.10 vs. 9.06±1.89; postprandial glucose level 2 hours after breakfast (mmol/L): 12.26±3.78 vs. 14.11±5.28, 12.47±3.63 vs. 14.00±3.88; HbA1c: 0.074±0.014 vs. 0.082±0.023, 0.076±0.014 vs. 0.081±0.016; Log UACR (mg/g): 1.63±1.56 vs. 2.25±1.44, 1.84±1.65 vs. 2.43±1.56, all P < 0.05], but there was no statistical significance between the two groups [fasting glucose level (mmol/L): -1.10±0.47 vs. -0.85±0.36, postprandial glucose level 2 hours after breakfast (mmol/L): -1.85±0.88 vs. -1.53±0.68, HbA1c: -0.008±0.004 vs. -0.006±0.003, Log UACR (mg/g): -0.61±0.29 vs. -0.59±0.29, all P < 0.05]. There were no significant changes in blood pressure, serum creatinine and eGFR in the two groups before and after intervention. There were 18 and 24 patients with hypertension in co-management group and specialist management group, respectively. The utilization rates of ACEI/ARB in both groups after intervention were significantly higher than those before intervention [88.9% (16/18) vs. 22.2% (4/18), 95.8% (23/24) vs. 29.2% (7/24), both P < 0.01]. At the end of the study, the utilization rate of ACEI/ARB was similar between the two groups [88.9% (16/18) vs. 95.8% (23/24), P > 0.05].@*Conclusion@#Both "diabetes specialists-community general practitioners-community nurse co-management mode" and "diabetes specialist management mode" can effectively decrease glucose levels and UACR levels of patients with type 2 diabetes as well as the standard use of antihypertensive agents, which has positive effects on the prevention and treatment on DN.
ABSTRACT
Objective To explore the effect of "diabetes specialists-community general practitioners-community nurse co-management mode" and "diabetes specialist management mode" on diabetic nephropathy (DN) in primary medical institutions. Methods Patients with type 2 diabetes admitted to Quanzijie Health Clinic of Jimusar County of Xinjiang Uygur Autonomous Region from October 2017 to March 2018 were enrolled. The Patients were divided into co-management group or specialist management group according to their administrative villages. The treatment plans of the two groups were formulated with reference to the current guidelines. The subjects of the co-management group were jointly managed by a fixed team composed of diabetes specialists from Jimusar Traditional Chinese Medicine Hospital, community general practitioners and community nurses from Quanzijie Health Clinic, and required to attend diabetes education courses every month. The diabetes specialist of Jimusar Traditional Chinese Medicine Hospital was responsible for the formulation and management of the treatment plan of the research object. Follow-up was fulfilled once every 4 weeks for 24 weeks in two groups. Before and after intervention, blood glucose, blood pressure, urinary albumin/creatinine ratio (UACR), estimated glomerular filtration rate (eGFR) as well as the utilization rate of angiotensin converting enzyme inhibitors/angiotensin Ⅱ receptor blocker (ACEI/ARB) were collected. Results A total of 115 patients accomplished this study with 54 patients in co-management group and 61 patients in specialist management group. After 24 weeks of intervention, fasting glucose level, postprandial glucose level 2 hours after breakfast, glycosylated hemoglobin (HbA1c), Log UACR in co-management group and specialists management group were significantly decreased compared with baseline [fasting glucose level (mmol/L): 8.06±1.92 vs. 9.16±2.83, 8.21±2.10 vs. 9.06±1.89; postprandial glucose level 2 hours after breakfast (mmol/L): 12.26±3.78 vs. 14.11±5.28, 12.47±3.63 vs. 14.00±3.88; HbA1c: 0.074±0.014 vs. 0.082±0.023, 0.076±0.014 vs. 0.081±0.016; Log UACR (mg/g): 1.63±1.56 vs. 2.25±1.44, 1.84±1.65 vs. 2.43±1.56, all P < 0.05], but there was no statistical significance between the two groups [fasting glucose level (mmol/L):-1.10±0.47 vs. -0.85±0.36, postprandial glucose level 2 hours after breakfast (mmol/L):-1.85±0.88 vs. -1.53±0.68, HbA1c:-0.008±0.004 vs. -0.006±0.003, Log UACR (mg/g):-0.61±0.29 vs. -0.59±0.29, all P < 0.05]. There were no significant changes in blood pressure, serum creatinine and eGFR in the two groups before and after intervention. There were 18 and 24 patients with hypertension in co-management group and specialist management group, respectively. The utilization rates of ACEI/ARB in both groups after intervention were significantly higher than those before intervention [88.9％ (16/18) vs. 22.2％ (4/18), 95.8％ (23/24) vs. 29.2％ (7/24), both P < 0.01]. At the end of the study, the utilization rate of ACEI/ARB was similar between the two groups [88.9％ (16/18) vs. 95.8％ (23/24), P > 0.05]. Conclusion Both "diabetes specialists-community general practitioners-community nurse co-management mode" and "diabetes specialist management mode" can effectively decrease glucose levels and UACR levels of patients with type 2 diabetes as well as the standard use of antihypertensive agents, which has positive effects on the prevention and treatment on DN.
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OBJECTIVE： To explore the management model of smart pharmacy under the background of “Internet+TCM”， and to promote the improvement of the work and service quality of smart pharmacy. METHODS： The information platform and internal organization of smart pharmacy in our hospital were combined； the supervision and management of smart pharmacy and the establishment of quality control system in smart pharmacy were summarized and the development and supervision effectiveness of smart pharmacy in our hospital were evaluated. RESULTS： Our hospital established the information platform on the basis of the “Internet+TCM”. Hospital information setting were divided into online and offline. The prescriptions that were not suitable for online handling decoction and distribution service were clearly defined and the system locking settings were set up to realize effective information transmission from hospital to smart pharmacy. The service platform of smart pharmacy were set up including electronic prescription circulation system， whole-course prescription barcode recognition management system， electronic prescription audit and dispensing system， intelligent decoction control management system， smart pharmacy distribution management system， etc. It had realized seamless connection of information between smart pharmacy and patients. The internal organization included six departments： prescription audit center， dispensing center， decoction center， individualized preparation production center， logistics center and customer service center. Our hospital conducted daily supervision and management of the entire work process of the smart pharmacy from aspect of hospital management and pharmacy management. The internal service quality of smart pharmacy could be controlled by quality control system of prescription reviewing center， dispensing center， decocting center， individualized preparation center， logistics center and customer service center and pharmaceutical personnel training mechanism in smart pharmacy. Since the start of the smart pharmacy in June 2015， the number of people receiving the services of smart pharmacy had increased significantly， and the types of services and service opportunities for patients had added； the distribution service had added， and the service of individualized preparation processing and distribution had also added. Moreover， the service capacity of smart pharmacy far exceeded the demand of our hospital， and other medical institutions could share the platform of smart pharmacy. By simply counting the situation in our hospital， the average number of daily prescription increased from 387 in Jun.-Dec. of 2015 to 1 433 in 2018； the error rate showed a downward trend， among which the abnormal rate of prescription reviewing， the dispensing error rate， the decoction error rate and customer service complaints rate decreased from 2.10％， 0.13％， 0.52％， 0.13％ in Jun.-Dec. of 2015 to 0.45％， 0.05％， 0.27％， 0.04％ in 2018； total timely investment rate in logistics increased from 93.20％ in Jun.-Dec. of 2015 to 97.06％ in 2018. At present， the existing information platform， internal organization， quality control system and supervision system could ensure the orderly operation of smart pharmacy and could ensure the quality of drugs， decoction and distribution. CONCLUSIONS： However， the development of smart pharmacy in our hospital is still in its infancy. In the future， it is still necessary to strengthen the construction of information software and hardware， standardize the operation of various links， strengthen personnel training， establish an effective quality control system and explore more objective supervision mechanisms.