Exploration of influential factors for job satisfaction of pharmacists in secondary and tertiary hospitals of China / 中国药房

OBJECTIVE To provide reference for improving the professional identity of clinical pharmacists and the quality of pharmaceutical care ，and promoting the effects of clinical pharmaceutical intervention. METHODS A questionnaire survey was conducted among clinical pharmacists in secondary and tertiary hospitals in 31 provinces（autonomous regions and municipalities ） in 2019 by stratified semi-random sampling. Through descriptive analysis of survey data ，their job satisfaction status was evaluated ； χ 2 test and Logistic regression analysis were used to analyze the influential factors of job satisfaction ；the robustness test of study results by propensity score matching method and replacement regression model ，and grouping Logistic regression of samples from hospital on different levels. Targeted improvement measures were put forward according to the results of survey . RESULTS There was statistical significance in the difference of job satisfaction among pharmacists of different professional titles （P＜0.05）. Results of Logistic regression showed that whether to participate in standardized training ，whether to obtain communication and support from patients ，whether the pharmaceutical management rules and regulations were sound ，whether to set up economic compensation means such as pharmaceutical service fee ，whether to work overload ，and whether to smoothly perform pharmaceutical care duties were significant influential factors for job satisfaction of clinical pharmacists （P＜0.05）. These results showed good robustness as tested by propensity score matching method and replacement regression model. Heterogeneity analysis results showed that the job satisfaction of clinical pharmacists in tertiary hospitals was more significantly affected by economic compensation ，while clinical pharmacists in secondary hospitals were more concerned about training opportunities and workload conditions （P＜0.05）. CONCLUSIONS The job satisfaction level of Chinese clinical pharmacists remains to be improved. Accordingly ，it is compulsory to continue the promotion of standardized training courses ，consummate the pharmaceutical management system ，and fair remuneration structure in order to improve the job satisfaction of clinical pharmacists and build a high-level clinical pharmacist team.

Investigation and analysis of clinical blood supply in Xi′an / 中国输血杂志

【Objective】 To explore the development and changes of blood use in various hospitals through statistical analysis of clinical blood use data in Xi′an, so as to provide basis for the decision making of blood banks to formulate and adjust the blood donation recruitment, collection, preparation and supply plan. 【Methods】 The clinical blood supply data of Shaanxi Blood Center from 2015 to 2019 were collected, and statistical analysis was conducted in terms of red blood cells, plasma, platelets, and cryoprecipitate. 【Results】 The blood supply in Xi′an showed an upward trend from 2015 to 2019, and the blood supply in 2019 was the highest in history(737 852 U). Both tertiary hospitals and secondary hospitals had shown an increasing trend in blood consumption, and the average consumption of red blood cells and plasma per person in operation kept decreasing year by year. The consumption of red blood cells in municipal hospitals and private hospitals had increased greatly, and the average consumption of red blood cells per person in operation had shown a downward trend. The amount of platelet use in all kinds of hospitals increased significantly. The proportion of platelet supply in the total annual blood supply kept increasing year by year. The ratio of platelet consumption to red blood cells consumption (hereinafter referred to as platelet-to-red blood cells ratio) in tertiary hospitals was higher than that in secondary hospitals. The platelet-to-red blood cells ratio of all kinds of hospitals had increased year by year. 【Conclusion】 The increase in the number of clinical diagnosis and treatment is the main reason for the increasing demand for clinical blood supply year by year. On this basis, the government and blood banks can predict the clinical blood demand and adjust the plan of blood donation in time. There is still much room for improvement in the annual platelet collection in Xi′an. Hospitals with higher levels of clinical disciplines have relatively high plate-to-blood ratios.The ratio of plasma to red blood cells consumption in tertiary hospitals is abnormal, there might be unreasonable use of blood.

National Survey on Clinical Pharmacy Services of Second-level Hospitals in China:Part 2. Analysis on the Status Quo of Clinical Pharmaceutical Services / 中国药学杂志

OBJECTIVE: To collect relevant data on the development of clinical pharmaceutical services in secondary hospitals in China and analyze the existing problems of clinical pharmaceutical services and provide relevant policy suggestions. METHODS: A face-to-face interview survey was conducted to collect data on the secondary hospital clinical pharmacists′ perception of their own work, physicians′ knowledge of clinical pharmacists′ work and patient′s attitude toward clinical pharmacists′ work, et al which was analyzed with descriptive statistics tools. RESULTS: Among the clinical pharmacists, physicians, and patients surveyed, 52.8% of clinical pharmacists think that the clinical pharmacists in the hospital work smoothly, but 35.8% of clinical pharmacists think the configuration of clinical pharmacists in the hospital is unreasonable; 42.0% of the doctors had a basic understanding of the work of clinical pharmacists; the attitude of the clinical pharmacists on medication recommendations or dosing regimens was mainly partly adopted (82.5%). Most of the patients did not understand but had heard of clinical pharmacy services (39.7%).CONCLUSION: The work and assignment of clinical pharmacists, understandings between clinical pharmacists and physician, patients of secondary hospitals in China require further improvement.

Survey and analysis of knowledge, attitude and practice of physical restraint on critical parents in secondary hospitals and tertiary hospitals in Hubei province / 中国实用护理杂志

Objective To investigate the situation of knowledge,attitude and practice of physical restraint from nurses for critical parents in secondary hospitals and tertiary hospitals in Hubei province.Methods 300 nurses from four tertiary hospitals and four secondary hospitals were investigated for the situation of knowledge,attitude and practice of physical restraint by questionnaires.Results It showed that nurses had a good knowledge of physical restraint,(11.02±1.96),their attitude of physical restraint tended to be neutral,(34.99±3.52),the practice of physical restraint turned out to be at meddle-up level,(51.90±6.67).There was a statistically significant difference in the scores of physical restraint knowledge and practice between nurses who receive physical restraint train or not after they got a job,besides,there was also statistically significant difference in the scores of physical restraint knowledge between intensive department and non-intensive department,tertiary hospitals and secondary hospitals,however there was no statistically significant difference in the scores of physical restraint attitude and practice between them.Conclusions Compared with non-intensive department and secondary hospitals,the nurse managers of intensive department and tertiary hospitals should strengthen the training and education of physical restraint of clinical nurses,guide the nurses to build the positive attitude of physical restraint,to reduce the use of preventive physical restraint and then to promote their quality of practice on physical restraint.

Effectiveness analysis on management of antimicrobial agents within three years / 中国感染控制杂志

Objective To analyze antimicrobial use in the different grades of hospitals within 3 years after the car-rying out of rectification activities of antimicrobial use,and provide basis for making continuous improvement pro-gram of antimicrobial management.Methods Retrospective analysis was performed,outpatient and emergency pre-scriptions and medical records of discharged patients (100 were type Ⅰ incision surgery)were selected from 5 tertia-ry hospitals and 5 secondary hospitals within 3 months,antimicrobial use and management were investigated. Results 200 outpatient prescriptions,100 emergency prescriptions,and 200 medical records of discharged patients were selected from each hospital.In tertiary and secondary hospitals,antimicrobial usage rate in outpatient prescrip-tions was 17.40% and 18.00% respectively,emergency prescriptions was 31 .60% and 40.10% respectively;a-mong inpatients,antimicrobial usage density(AUD)was (28.13±8.04)and (49.67±11 .63)respectively,and anti-microbial usage rate was 41 .30% and 56.20% respectively;pathogenic detection rate of antimicrobial therapeutic cases was 45.70% and 22.70% respectively,therapeutic cases with limit level of antimicrobials was 61 .50% and 27.40% respectively;antimicrobial usage rate in type I incision surgery was 20.00% and 40.40% respectively;The rational rate of antimicrobial types was 94.60% and 59.20% respectively,rational rate of opportunity of antimicro-bial use was 95.20% and 48.20% respectively;combination rate was 8.80% and 36.60% respectively,and rational rate of treatment course was 84.00% and 52.80% respectively.Conclusion In tertiary hospitals,antimicrobial use after 3 years rectification of antimicrobial use conform to the antimicrobial management requirement of Ministry of Health,the overall quality index is better than secondary hospitals,management of antimicrobial in secondary hos-pitals use should be improved.

Experiences and the special medical conditions for a Chinese secondary hospital on the early stage of arterial switch operation / 中华胸心血管外科杂志

Objective This retrospective study is to analysis the special medical conditions that most Chinese secondary hospitals are facing with,and to review the safeguards and pitfalls for arterial switch operations,in order to probe intothe feasibility of this procedure for Chinese secondary hospitals and provide our experiences to help other surgeons to avoid pitfalls on complex procedures.Methods Between January 2006 and December 2011,totally 21 newborns and infants with TGA/VSD and TGA/IVS underwent arterial switch operation.There were 15 males and 6 females.In the TGA/VSD group,there were 16 cases,ranging from 30 days to 1 year at surgeries,and weight from 3.4-8.5 kg with average of (5.33 ± 1.42) kg.In the TGA/IVS group,there were 5 cases,ranging from 13 days to 1 month at surgeries,and weight from 3.1-5.5 kg with average of (3.75 ± 1.17)kg.All patients underwent one stage of arterial switch operation.Routine follow-up checking points are set at discharging,3 months,half year and every year after operation.Results The early death rate is 9.5％ (2/21),and the reexploration rate is 9.5％ (2/21).In the TGA/VSD group,average cardiopulmonary bypass time is (151 ± 33) minuntes with the aortic crossclamp time is (1 19 ± 26) minutes.Ventilator support time is 24-159 hours,and the length of ICU stay is 3-17 days.1 case has residual VSD with the diameter less than 2 mm.The pulmonary flow velocity in 2 cases increase mildly to 2.0 m/s and 2.2 m/s,and another 2 cases increase severely to 3.1 m/s and 3.7 m/s.The aortic flow velocity in 3 cases increase to 2.0m/s.ECG instructs no case has myoinfarction signs.In the TGA/IVS group,average cardiopulmonary bypass time is (170 ± 52) minuntes with the aortic crossclamp time is (137 ± 48) minutes.Ventilator support time is 51-144 hours,and the length of ICU stay is 4-14 days;The pulmonary flow velocity in 2 cases increase mildly to 2.0 m/s.The aortic flow velocity in 1 cases increase to 2.0 m/s.ECG instructs no case has myoinfarction signs.Conclusion Unbalanced medical resources distribution causes significant differences between heart centers and the secondary hospitals in China,especially on the complex congenital heart diseases procedures.However,with relatively solid background on correction of the simple congenital heart diseases,the Chinese secondary hospitals can still perform arterial switch operation with satisfactory mortality and morbidity,and provide more prompt medical services for more population.

Third-generation cephalosporin resistance of community-onset Escherichia coli and Klebsiella pneumoniae bacteremia in a secondary hospital

BACKGROUND/AIMS: To enable appropriate antimicrobial treatment for community-onset infections in emergency departments (EDs), data are needed on the resistance profiles of Escherichia coli and Klebsiella pneumoniae, which are the main pathogens of community-onset bacteremia. METHODS: Records were reviewed of 734 patients with E. coli and K. pneumoniae bacteremia who visited the Daegu Fatima Hospital ED, Daegu, Korea between 2003 and 2009. We investigated the demographic data, clinical findings, and antimicrobial susceptibility patterns of the organisms. RESULTS: Of 1,208 cases of community-onset bacteremia, 62.8% were caused by E. coli or K. pneumoniae in an ED of a secondary care hospital. Five hundred and forty-eight cases of E. coli (75%) and 183 cases of K. pneumoniae (25%) were analyzed. Urinary tract infection (43.1%) was most common, followed by intra-abdominal infection (39%) and pneumonia (7.2%). Trimethoprim/sulfamethoxazole, fluoroquinolone, third-generation cephalosporin (3GC) and amikacin resistance rates among E. coli and K. pneumoniae were 22.8%, 19.6%, 6.2%, and 1.3%, respectively. In 2009, the rate of 3GC resistance (10.6%) was significantly higher, compared to the annual averages of 2003 to 2008 (6.1%; p = 0.03). Previous exposure to antibiotics was an independent risk factor for 3GC resistance in multivariate logistic regression analysis. CONCLUSIONS: The rate of 3GC resistance increased in community-onset infections, and previous exposure to antibiotics was an independent risk factor. Despite the increased 3GC resistance in community-onset infections, an amikacin combination therapy could provide an option for treatment of bacteremic patients with previous antibiotic exposure in an ED.

The study of job satisfaction of secondary hospital doctors / 中华行为医学与脑科学杂志

Objective To realize job satisfaction of doctors from the secondary hospital and its influencing factors and put forward countermeasures for doctor job satisfaction.Methods 2066 doctors from the secondary hospital were investigated by self-made scale,and analyzed by analysis of variance,non-conditional logistic regression analysis and other methods.Results The average score of total job satisfaction of doctors was (3.44±0.95),in which about 57.6% of doctors expressed satisfaction with the current work.The scale of job itself satisfaction had the hisheet score,that was (3.91±0.79),while the scale of job retum satisfaction had the lowest score,that was (2.85±1.16).Leadership behavior played the most decisive role in doctors job satisfaction(sβ=0.7,P<0.01).Condusion The total job satisfaction of secondary hospital doctors is just above the average and doctors are most dissatisfied with the work concentrated in the areas of return and the practice environment.

The Results of Gastric Cancer Surgery during the Early Stage of a Training Hospital

PURPOSE: Konkuk University Hospital (KUH), which opened in September 2005, is currently categorized as a secondary hospital. Early on after its establishment, the surgical residents and nurses were relatively inexperienced in the treatment of stomach cancer. Therefore, the quality of surgery for stomach cancer at KUH may be different from that of the existing large-scale tertiary hospitals. The purpose of this study is first to investigate the clinicopathological characteristics of the gastric cancer patients at the KUH, and second to compare our morbidity & mortality rates with those of previous studies, and we also analyzed the risk factors of morbidity at the early stage of a training hospital. MATERIALS AND METHODS: This study retrospectively collected the clinicopathological characteristics and the post-operative morbidity rates and mortality rates with using the electronic medical records of all the patients who went under a gastric cancer operation at KUH from September 2005 to April 2008. RESULTS: The total number of gastric cancer patients who underwent operation was 201. The morbidity rate and death rate at KUH were 10.4% and 0.5%, respectively. The morbidity has increased with an older age. The other variables had no influence on morbidity. CONCLUSION: The morbidity rate, death rate and the clinicopathological characteristics of gastric cancer patients at KUH were similar to those of the previous reports. We found that age is the main factor affecting the morbidity rate after stomach cancer surgery. For further surgical qualification of stomach cancer surgery at KUH, it is necessary to collect the survival data of patients who undergo stomach cancer surgery.

A Clinical Study of Acquired Paralytic Strabismus in a Secondary Hospital

PURPOSE: To analyze the clinical course of acquired third, fourth, and sixth cranial nerve palsy at a secondary hospital. METHODS: We analyzed the medical records of 26 patients, 28 eyes who were diagnosed third, fourth, and sixth nerve palsy from March 2004 to September 2005. The clinical courses, affected cranial nerves, etiologic factors and recovery rates were examined retrospectively. RESULTS: The sixth cranial nerve was affected most frequently (12 eyes, 49.2%), followed by the third nerve (11 eyes, 17.9%). Vascular etiologic factors was most common (12 eyes, 42.9%). Only two cases were associated with neurosurgical diseases. Of the 28 eyes that were followed up for at least 3 months, 21 (75.0%) eyes showed a decrease in the angle of deviation. Of these, 14 (50%) eyes recovered completely. CONCLUSIONS: There are many vascular and undetermined etiologic causes of cranial nerve paralysis at 2nd grade hospital. So little cases are result from neurosurgical etiology. There are limitations in finding the affecting factors. Further evaluations for the factors associated with increasing recovery rates were needed.

Optimization of the Administrative Organization Structure & Implementation of Secondary Hospital Service Model in Our Hospital / 中国药房

OBJECTIVE: To facilitate the practice of the activity of "hospital administration year" and to improve the medical service quality. METHODS: Reformation was made actively by optimizing the administrative organization structure and introducing the model of secondary hospital service in our hospital after the trusteeship by the Shanghai 6th People's Hospital. RESULTS & CONCLUSIONS: Due to the above practice, the consciousness on medication safety, the quality of medical care services as well as the degree of patients' satisfaction had been increased gradually, which contributed to a sound, ordered and sustainable development of our hospital.