A survey of patients' satisfaction with referral in a class A tertiary hospital / 预防医学

Objective@# To investigate patients' satisfaction rate towards referral in a class A tertiary hospital, so as to provide the evidence for promoting the highly efficient implementation of referral. @*Methods @#The gender, age, type of referral, referral efficiency and referral cost of patients receiving referral services in 2021 were collected through the interconnected intelligent hierarchical diagnosis and treatment collaborative platform of Henan Provincial People's Hospital. Patients' awareness and recognition of the two-way referral system were investigated using questionnaire surveys, and factors affecting patients' satisfaction with referral were identified using a multivariable logistic regression model.@* Results@# A total of 1 268 patients receiving referral services were surveyed, including 576 men (45.43%) and 692 women (54.57%), and the respondents were predominant at ages of 18 years and older (935 cases, 73.74%). There were 535 cases with overdue referral (42.19%) and 1 157 cases with free referrals (91.25%). There were 749 cases that were aware of the two-way referral system (59.07%), and 587 cases recognized the two-way referral system (46.29%). There were 975 patients with a satisfactory attitude towards referral, with a satisfaction rate of 76.89%. There were 1 030 cases (81.23%) that considered fluent communication of referral information, with a 78.54% satisfaction rate towards referral; 569 cases (44.87%) that considered simple referral procedures, with an 81.37% satisfaction rate towards referral, and 797 cases that were satisfied with the services provided by the referred medical staff (62.85%), with a 79.42% satisfaction rate towards referral. Multivariable logistic regression analysis showed that non-overdue referrals (OR=1.846, 95%CI: 1.411-2.414), free referrals (OR=1.815, 95%CI: 1.188-2.773), awareness of the two-way referral system (OR=0.624, 95%CI: 0.472-0.826), recognition of the two-way referral system (OR=1.621, 95%CI: 1.235-2.129) were factors affecting the satisfaction with referral.@*Conclusions@# The satisfaction rate towards referral was 76.89% among the study patients, and the awareness and recognition of the two-way referral system, referral efficiency and convenience are factors affecting the satisfaction with referral.

Pattern and determinants of outcomes of neurological emergencies admitted into children emergency ward in a tertiary hospital in Port Harcourt, Nigeria

Neurological emergencies are life-threatening central nervous system disorders, significantly contributing to childhood morbidity and mortality. The sequelae may be irreversible and may impact negatively on the quality of life of affected children and their families. This study identified the morbidity pattern and determinants of the outcomes of children with neurological emergencies in the Children Emergency Room (CHER) of the Rivers State University Teaching Hospital (RSUTH). Method: A 4-year retrospective study was carried out in the CHER. Data on demography, diagnosis and outcomes of children with neurological disorders were extracted from the records. Data analysed with SPSS 24 were expressed in percentages and frequency tables. Results: Of the 3040 children admitted in the CHER, 364(12%) aged 0-15 years had neurological emergencies, commoner among males (59.3%) and children aged less than five years (70.9%). Meningitis (40.2%) and febrile convulsion (28.2%) were the topmost diagnoses made. Raised intracranial pressure (17.4%) and head injuries (25.5%) were significantly more prevalent among children aged five years and above. The mortality rate was 61(16.8%) and more among adolescents (30.6%). All the mortalities took place within the first 48hours of admission especially among those with head injuries (46.5%) and perinatal asphyxia (95%), (p < 0.05). Conclusion: Meningitis and febrile convulsion were the commonest neurologic emergencies seen in this study. Mortality rate was high, especially in the first 48 hours of admission and mainly from perinatal asphyxia and head injuries. Education on the prevention and management of neurologic emergencies should be strengthened

Interventions to improve health literacy in Nigeria: systematic review of effectiveness and policy recommendations

Background: Health literacy plays a crucial role in enabling individuals to navigate and make informed decisions within the healthcare system. It encompasses the ability to understand, interpret, and act upon medical information and instructions, as well as the capacity to source and analyse relevant health information for preventive measures and self-care. This paper explores the interventions aimed at improving health literacy in Nigeria and synthesizes policy recommendations for the Nigerian government. Method: A systematic literature review based on the PRISMA methods was carried out to identify published interventions and reported effectiveness in the Nigerian population. A search strategy using key words health literacy and health interventions was executed in PubMed, Embase and African Index Medicus. A total of 268 records were screened for relevance and 18 were identified. Results: Of the 18 reports identified, 13 interventions were effective, 3 interventions had mixed results reporting effectiveness in some domains and ineffectiveness in other important domains, while 2 interventions were not effective. The nature of effectiveness in the interventions was based on the outcomes as reported in the identified studies. Conclusion: The health literacy situation in Nigeria provides a background into some of the challenges faced in achieving universal health coverage and promoting health in Nigeria. Low literacy rates, particularly in its many rural areas, the lack of functional, communicative, and critical health literacy competencies among many adults, as conceptualised in literature pose a significant obstacle to health literacy development in Nigeria. Many of the health literacy interventions have been effective to address various aspects of health literacy on a rather small scale. To comprehensively address the problem, collaborative efforts involving the government, healthcare professionals, non-governmental organisations, media, and the community are necessary.

Pattern and determinants of outcomes of neurological emergencies admitted into children emergency ward in a tertiary hospital in Port Harcourt, Nigeria

Background: Neurological emergencies are life-threatening central nervous system disorders, significantly contributing to childhood morbidity and mortality. The sequelae may be irreversible and may impact negatively on the quality of life of affected children and their families. This study identified the morbidity pattern and determinants of the outcomes of children with neurological emergencies in the Children Emergency Room (CHER) of the Rivers State University Teaching Hospital (RSUTH). Method: A 4-year retrospective study was carried out in the CHER. Data on demography, diagnosis and outcomes of children with neurological disorders were extracted from the records. Data analysed with SPSS 24 were expressed in percentages and frequency tables. Results: Of the 3040 children admitted in the CHER, 364(12%) aged 0-15 years had neurological emergencies, commoner among males (59.3%) and children aged less than five years (70.9%). Meningitis (40.2%) and febrile convulsion (28.2%) were the topmost diagnoses made. Raised intracranial pressure (17.4%) and head injuries (25.5%) were significantly more prevalent among children aged five years and above. The mortality rate was 61(16.8%) and more among adolescents (30.6%). All the mortalities took place within the first 48hours of admission especially among those with head injuries (46.5%) and perinatal asphyxia (95%), (p < 0.05). Conclusion: Meningitis and febrile convulsion were the commonest neurologic emergencies seen in this study. Mortality rate was high, especially in the first 48 hours of admission and mainly from perinatal asphyxia and head injuries. Education on the prevention and management of neurologic emergencies should be strengthened.

Quality of Life of Type 2 Diabetic Patients attending a Tertiary Hospital in South-South Nigeria

Background: Type 2 Diabetes mellitus affects the quality of life of individuals and their ability to function. It affects the physical, social and mental well-being of patients with immediate and delayed complications.This study determined the quality of life of type 2 diabetic patients attending a tertiary hospital in south-south Nigeria.Methods:This was a descriptive cross-sectional study conducted among type 2 diabetic patients attending the medical outpatient clinic of the University of Port Harcourt Teaching Hospital between September and November 2019. Purposive sampling technique was used to select a total of 347 participants for the study following ethical approval. WHOQOL-BREF questionnaire was used to measure the QoL of the participants. Data were analyzed using SPSS version 23.0. Descriptive data were presented in frequency distribution tables while summary statistics were done using mean and standard deviation for continuous variables and in proportions for categorical variables. Results:Results revealed that majority of the type 2 diabetic patients were females (53.3%) and between the ages of 51-60 years. 27.2% of them had poor overall QoL with the score of <45% while 65.7% had fair overall QoL with a score of 45-65 %. 7.1% had good overall QoL with a score of ≥65%. Conclusion:Majority of the type 2 diabetic patients had fair QoL while the least had good QoL. There is urgent need for increased health awareness and education of diabetic patients regarding diabetic care.

Core competency of doctors at tertiary public hospitals in regions of different income levels in China: a cross-sectional survey / 中华医院管理杂志

Objective:To explore the core competency of doctors in tertiary public hospitals in regions of different income levels in China, and provide reference for promoting such competency and related policy formulation.Methods:Using multi-stage stratified cluster sampling method, 195 tertiary public hospitals in 16 provinces of China were selected from November 2021 to March 2022. 200 doctors were sampled from each hospital. A self-designed questionnaire was used to investigate the status of doctors′ core competencies, as well as the status of their postgraduate medical education and continuing medical education. According to the per capita gross regional product of each province in China Statistical Yearbook 2022, each province was divided into high, middle and low income regions, and the questionnaire data were descriptively analyzed, while χ2 test was used to compare the differences between groups. Results:A total of 32 673 valid questionnaires were collected. There were 12 135 doctors (37.14%) in China who had received comprehensive education and training of core competency in all dimensions. Among the dimensions of self-rated core competency of the surveyed doctors, there were 10 019 doctors (30.66%) with insufficient teaching ability and 438 (1.34%) with insufficient professional quality, and there was no significant difference between regions ( P>0.05). There were 2 385 (27.08%), 2 528 (27.55%) and 3 646 (24.82%) doctors in high-, middle- and low-income regions with insufficient lifelong learning ability, respectively. The proportion of doctors in middle- and high-income regions was higher than that in low-income ones ( P<0.05). There were 1 317 (15.57%), 1 290 (14.06%) and 2 719 (18.51%) doctors with insufficient knowledge and skills in high-, middle- and low-income areas, respectively. The proportion of doctors in low-income regions was higher than that in middle- and high-income regions ( P<0.05). The proportion of doctors who did not receive any kind of postgraduate medical education or continuing medical education in low-income regions was 7.33% (1 077 people), higher than that in high-income and middle- income ones ( P<0.05); 50.44% (4 442 people) of surveyed doctors in high-income regions believed that for standardized training of resident physicians (hereinafter referred to as residential training), the clinical teachers were " overworked to take this job", which was higher than that in middle- and low-income regions ( P<0.001); In middle-income regions, 46.16% (4 235 people) and 43.46% (3 987 people) believed that the salary residents and specialized physicians in standardized training (hereinafter referred to as specialized training) was too low, while 42.47% (3 897 people) and 30.44% (2 793 people) believed that the clinical practice opportunities of students were limited, both of which were higher than those in high-income and low-income regions ( P<0.001); 34.91% (5 128 people) of surveyed doctors in low-income regions believed that the investment was insufficient for training bases of residential training, 27.81% (4 085 people) of those held that training bases for specialized training were unevenly distributed, and 33.19% (4 876 people) of those held that continuing medical education was plagued by " insufficient promotion coverage, and insufficient opportunities for primary doctors", all of which being higher than those in high- and middle-income regions ( P<0.001). Conclusions:There is an obvious need to improve the core competence of doctors in the teaching ability dimension of tertiary public hospitals in China, especially in middle- and high-income regions for lifelong learning, and in low-income regions for knowledge and skills; There are differences between postgraduate medical education and continuing medical education systems in regions of different income levels in China. It is necessary to improve the competency oriented postgraduate medical education and continuing medical education systems.

KNOWLEDGE AND PERCEPTION OF WORKERS IN NONPATIENT CARE AREAS OF A TERTIARY HOSPITAL REGARDING PREVENTION AND SPREAD OF COVID-19

INTRODUCTIONThe novel coronavirus also known as severe acute respiratory syndrome coronavirus-2(SARS-COV2) causes a severe respiratory disease known as covid 19 because this strain wasdiscovered in December 2019, in Wuhan, China [1,2]. It was reported first on the 31st ofDecember, 2019, by the WHO and regarded as a global pandemic on 11th march 2020[3]. Itcrossed boundaries worldwide and affected millions of people all over the world. In India, theaverage daily cases are nearly 98000 cases and the numbers are rising every day.MATERIALS AND METHODSIt is a questionnaire-based survey, taken by a total of 80 respondents, who were posted innon-patient care areas of a tertiary care hospital and the questionnaire was framed usinginformation from the world health organization (WHO), UpToDate, Indian council ofmedical research (ICMR), Centre for disease control (CDC) and National Institute of Health(NIH) website resources.RESULTOut of 80 workers, 51.25% workers were permanently employed in the setup (figure 1).Highest in the job category of store manager, tailor and chowkidar, while the highest numberof contractual workers were employed as supervisor, there were no contractual workersemployed as tailor, chowkidar and store manager in the hospital. Out of 80 workers, highestnumber of workers were employed in the category of administrators (16.25%) followed bykitchen staff (13.75%).CONCLUSIONTo conclude, the degree of awareness portrayed by the staff posted in non-patient care areasof the hospital is adequate to some extent, yet it lacks in certain dimensions like covid-19transmission and awareness regarding myths and beliefs. Based on this survey it isrecommended that all non-frontline workers posted in non-patient care areas of the hospitalshould at least be trained in order to increase their awareness and knowledge on thetransmission modes and prevention of COVID-19.

A comparative study to assess prescription pattern, cost, and appropriateness of antimicrobial usage in a rural government tertiary care hospital and rural private practitioners

Background: Antimicrobial resistance is defined as the ability of microorganism (bacteria, fungus, virus, or parasite) to resist the effects of a drug to inhibit microorganism growth, which is becoming a major concern worldwide particularly in developing country like India. Aim and Objectives: The aim of this study was to identify, compare, and assess the appropriateness of antimicrobials prescribed in a rural tertiary care hospital and those prescribed by rural private practitioners and to assess the average cost of antimicrobials per prescription. Materials and Methods: A cross-sectional study was conducted, in which a total of 2003 prescriptions were analyzed from outpatient department (OPD) of rural tertiary and prescriptions from nearby chemist shops for prescription pattern, cost, and appropriateness. Results: It was identified that most of the antimicrobial containing prescriptions in both private and public health sector were prescribed by MBBS doctors (56.33%). In Government Medical College (GMC) OPDs, antimicrobials were prescribed mostly for gastrointestinal infection (25.75%) and beta lactams (45.23%) followed by fluoroquinolones (27.10%) were the most commonly prescribed. While among rural private practitioners, gastrointestinal infections (33.50%) followed by fever (27.70%) were the most common clinical conditions, for which antimicrobials were prescribed and 13.40% prescriptions contained more than one antimicrobial. About 43.37% of antimicrobials prescribed in OPDs of GMC and 56.20% antimicrobials prescribed by private practitioners were found to be inappropriate which was statistically significant. Conclusion: The study concluded that around half of the prescriptions analyzed were inappropriate and so there is a strict need of supervising the antimicrobials prescribing patterns, consumption, and it’s dispensing from the pharmacy shops.

In-hospital severe COVID-19 in a philanthropic tertiary hospital setting: is asthma a concern? A retrospective study

ABSTRACT BACKGROUND: The frequency of coronavirus disease 2019 (COVID-19) cases among asthmatics has been reported to be reduced. However, the findings regarding the association between asthma and the risk of severe COVID-19 have been divergent. OBJECTIVE: To investigate whether asthma is associated with a reduced risk of development of severe COVID-19. DESIGN AND SETTING: Retrospective analysis on COVID-19 surveillance databases at two tertiary-level hospitals in São Paulo, Brazil. METHODS: The medical records of patients hospitalized due to COVID-19 between March and August 2020 were reviewed in accordance with the clinical, laboratorial, radiological and epidemiological criteria for COVID-19, and for comorbidities. RESULTS: Among the adult patients included (> 18 years of age) there were 52 asthmatics and 1,318 non-asthmatics. Their median ages and interquartile ranges (IQR) were, respectively, 54 (41-69) and 60 (44-72) years. At least one comorbidity was seen in 73% of asthmatics and 56% of the non-asthmatics. Among the asthmatics, most presented mild asthma (92%) and the prevalence of chronic obstructive pulmonary disease (COPD) was high (27%). The asthmatics presented an unadjusted odds ratio (OR) for severe COVID-19 of 0.89 (95% confidence interval, CI 0.5-1.56); and OR 0.88 (95% CI 0.5 -1.68) after multivariable adjustment. Age > 60 years, male sex, hypertension, diabetes, cancer and homelessness were covariates associated with increased odds for severe COVID-19. Kaplan-Meier estimated survival over hospitalization of up to 30 days did not differ between the groups (log-rank P = 0.09). CONCLUSIONS: The association between asthma and decreased risk of severe COVID-19 or increased survival was statistically non-significant.

Satisfaction survey of medical staff to the scientific research communication management mechanism of a tertiary hospital / 中华医学科研管理杂志

Objective:In order to improve the hospital scientific research communication management level, enhance the efficiency of hospital management, a survey on the satisfaction of the scientific research communication management mechanism among the medical employees in a third-grade hospital was conducted to explore its influencing factors, as well as to provide reference for improving the scientific research communication management system.Methods:A third grade hospital in Tianjin was selected as the questionnaire survey unit, 233 people were selected by stratified sampling method to conduct the questionnaire survey on their satisfaction with the communication management mechanism. SPSS 23.0 was used for single factor chi-square test and multivariate Logistic regression analysis.Results:The overall satisfaction of 233 employees surveyed was 88.4%. Single factor chi-square test results showed that different age, ″research managers actively communicate″, ″frequency″, "understanding the role of communication mechanisms″, ″understanding of the mechanisms of communication″, ″communication with senior management leadership″, ″communication mechanism in the team″, ″communication mechanism with other hospital team and departments″, ″familiar of the team plans and work progress″, ″form of obtaining scientific research information″, ″demands for obtaining scientific research information″, ″attitude towards scientific research information″ and other items had statistically significant association with satisfaction ( P<0.05). Multivariate Logistic regression analysis results showed that ″Science management personnel actively communicate″ (OR=0.129, 95%CI: 0.020-0.851), ″medium frequency of communication frequency″ (OR=0.254, 95%CI: 0.068-0.951), ″communication mechanism can ensure that most of the information is received″ (OR=0.073, 95%CI: 0.010-0.563), ″Good communication with superior management leadership″ (OR=0.044, 95%CI: 0.005-0.361), ″Good communication mechanism in team″ (OR=0.039, 95%CI: 0.010-0.563) were protective factors of medical employees′ satisfaction. Conclusions:The overall satisfaction of the medical employees in the third grade a hospital to the scientific research communication management mechanism is relatively high. However, further measurements still need to be carried out, including strengthen the popularization of communication mechanism and conduct communication with appropriate frequency. At the same time, the hospital should pay more attention to the role of team communication in the hospital scientific research communication management mechanism. Various ways and incentive mechanisms should be adopted to improve the satisfaction of medical employees on the hospital scientific research communication and communication management mechanism, and further to improve the efficiency of scientific research, be more productive, and create greater value for the hospital.

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.

An Evaluation of Renal Care received by Human Immunodeficiency Virus(HIV) Patients admitted in a Tertiary Hospital in Sierra Leone

INTRODUCTION: The burden of HIV is on the rise and patientswith HIV are also vulnerable to renal impairment from bothacute and chronic causes. This study sets out to evaluate renalcare received by such patients.METHODS: The study was conducted at Connaught Hospital,the main tertiary hospital (for medical and surgical cases) in thecountry. A retrospective review of all admitted patients withHIV between January and December 2019. Data was collectedusing a well- structured study proforma. RESULTS: A total of 230 patients were admitted with HIV duringthe study period. The mean age of patients was 36.9 ± (11.5) years with a female preponderance of 61.3%. A vast majority ofthe patients (54.8%) could afford to do some renal investigationsand only 13.9% were seen by renal physicians; 69.1% of patientswith azotaemia died while on admission.CONCLUSION: The extent of renal care observed from thestudy was poor because the majority of the patients were notseen b y r e na l physic ia ns a nd co uld no t affor d r e na linvestigations. Also, the occurrence of renal impairment inpatients with HIV suggests a poor prognosis. WAJM 2022;39(11): 1193­1197.

Analysis on the effect of medical resource reallocation in the relocation project of a tertiary hospital / 中华医院管理杂志

Objective:To analyze the impact created by the reallocation of a tertiary hospital on the neurosurgery inpatients volume in the functional core area of Beijing as the capital city, for reference to improve the healthcare resource reallocation policy.Methods:The data were obtained from the data sheet of discharged patients and the monthly report of medical statistics in Beijing. The study analyzed the average monthly neurosurgery inpatients volume, surgical beds and bed utilization rate of secondary or higher level hospitals from the core area, a tertiary hospital(hospital A), and as well as three tertiary hospitals(hospitals B, C and D)within 5 kilometers of Hospital A original location before and after the reallocation of Hospitls A. Periods of November 2017 to August 2018 and November 2018 to August 2019 respectively serve as the time frame before and after the relocation of Hospital A.Results:After the reallocation, the average monthly total inpatients volume, inpatients volume from other places, and local inpatients volume of neurosurgery at secondary or higher level hospitals in the core area decreased from 2 238, 1 610 and 628 to 1 526, 996 and 530 respectively. The inpatients volume changes were all statistically different( P<0.001). The number of neurosurgery inpatients in Hospital A and Hospital B increased from 983 and 659 to 1 316 and 934 respectively, as well as the number of neurosurgery inpatients in Hospital C and Hospital D did not change much. After the relocation of Hospital A, the number of surgical beds in secondary or higher level hospitals in the core area was reduced from 5 213 to 4 782, while that of Hospital A increased from 557 to 750, while the other three tertiary hospitals remained unchanged. The changes of bed utilization rate of the 4 hosptials were all less than 7.00%. Conclusions:After the reallocation Hospital A, the neurosurgery inpatient volume in the core area decreased, which was mainly contributed by the decrease of patients from other places, suggesting a positive outcome by the reallocation of healthcare resources in Beijing. On the other hand, it is necessary to study the influence of alternative medical resources on the reallocation effect.

Investigation and analysis on the cognition of scientific research integrity of authors of scientific and technological papers in a grade A tertiary hospital / 中华医学科研管理杂志

Objective:To understand the cognition of scientific research integrity of the authors of scientific and technological papers in a grade A tertiary hospital, the necessity and relevant needs of carrying out scientific research integrity construction, and provide a reference for improving the construction of relevant scientific research integrity system in the hospital.Methods:A questionnaire was used to survey 746 people who had published scientific and technological papers in a grade A tertiary hospital from 2016 to 2021, and the influencing factors of scientific research integrity cognition and construction were analyzed via a generalized linear model.Results:The overall awareness rate of scientific research integrity cognition of scientific papers was 76.72%, and the overall necessity rate of scientific research integrity construction was 77.75%. Generalized linear model analysis showed that other degrees refer to a doctor's degree, associate senior title, intermediate title, refer to junior title, or no title were negatively correlated with the cognition of scientific research integrity ( P<0.05), other ages refer to ≤30 years old, middle-level and above positions refer to no position, postgraduate mentor refer to non-postgraduate mentor, senior title refer to junior title or no title, postgraduate, nursing, administrative and research personnel refer to medical technology and pharmacy personnel, and presiding projects refer to no presiding project experience were positively related to scientific research integrity cognition ( P<0.05). Bachelor′s degree and no degree refer to doctor′s degree, associate senior and intermediate titles refer to junior title or no title were negatively related to the necessity of scientific research integrity construction ( P<0.05), middle level and above positions refer to no position, postgraduate, nursing and research personnel refer to medical technology and pharmacy personnel, were positively related to the necessity of scientific research integrity construction ( P<0.05). Behaviors with less than 60% cognition of scientific research integrity included the ethical problems of artificial intelligence, the ethical problems of stem cells, the problems of human genetic resources, and the definition of unauthorized human living drug and medical technology experiments. Conclusions:The hospital will take publicity and education as the basis, system norms as the criteria, daily supervision as the starting point, evaluation system as the core, carry forward the spirit of scientists, improve and implement the construction of the hospital's scientific research integrity system and supervision system, strengthen the integrity management of the whole process of scientific research activities, and guide medical personnel to practice excellent scientific research style and style of study.

Doctors and social media: knowledge gaps and unsafe practices

INTRODUCTION@#Easy access and availability of communication tools have facilitated doctors' communication, adding new challenges. Through this study, we aimed to determine the profile of the knowledge and practices of doctors in our institution, and to identify knowledge gaps in the use of social media accounts.@*METHODS@#An anonymous survey was sent by electronic mail in March-May 2018 to 931 doctors working in National University Hospital, Singapore. It included questions on demographics; use of social media; and case-based scenarios involving professionalism, patient-doctor relationship and personal practices of social media use.@*RESULTS@#The response rate was 12.8%. The majority of the respondents owned a social media account (93.3%), had not received education on social media use in medical school (84.0%), did not own a separate work phone (80.7%) and claimed to have no medical education on this as a doctor (58.8%). Unawareness of the institution's social media policy was reported by 14.3% of the respondents. Questions on knowledge of the privacy settings of their account were incorrectly answered. Only 75.6%-82.4% of the participants responded 'no' when asked if they would post pictures of patients or their results, even if there were no patient identifiers.@*CONCLUSION@#There is inadequate knowledge regarding institutional social media policy and privacy settings of social media accounts among doctors. Regarding practices in social media use, while most agree that caution should be exercised for online posts involving patients, ambiguity still exists. The emerging knowledge deficit and potentially unsafe practices that are identified can be addressed through continuing medical education and training on social media use.

The evaluation of scientific research efficiency in a tertiary hospital based on Data Envelopment Analysis: Application analysis with Slack Based Measure model / 中华医学科研管理杂志

Objective:To evaluate the Scientific Research Efficiency in A Tertiary Hospital, and provide recommendations for further improvement based on evaluation results.Methods:We evaluated the scientific research efficiency of 35 disciplines in a Tertiary Hospital from 2015 to 2017 with Slack Based Measure based Data envelopment analysis(DEA).Results:The average efficiency value from 2015 to 2017 is 0.44-0.65.The efficiency of Scientific Research from high to low was: supportive department, surgery department, internal medicine.There are 13 disciplines (37.14%) which efficiency increases gradually and 7 discipline (20%) which efficiency decreases.9 disciplines are DEA valid (efficiency=1) for at least 2 years and 9 is DEA invalid (efficiency<1) in three years.The average slack variable of researchers is 18.6 while average slack variable of input scientific research fund is 23.38 million RMB.Conclusions:The average efficiency of the tertiary hospital shows a rising trend.However, the efficiency of disciplines varies largely.For DEA invalid disciplines, it is important to improve efficiency by increasing output and improving efficiency of scientific research funding.

Study on the current situation and countermeasures of human genetic resources management in a tertiary hospital / 中华医学科研管理杂志

Objective:To analyze the current situation of human genetic resources management in a tertiary hospital, and propose improvement suggestions for the management of human genetic resources in tertiary hospitals.Methods:According to the review of laws and regulations of human genetic resources management in China, analyze the current situation, challenges and management suggestions of human genetic resources management in this particular tertiary hospital, and further management suggestions are proposed.Results:Main problems were identified in the tertiary hospital, including the knowledge of researchers needs to be improved, and due to lack of supervision and management on process of human genetic resources projects, the management of investigator initiated clinical trials needs to be further strengthened.Conclusions:The tertiary hospital needs to strengthen the researcher training on the management of human genetic resources, establish the whole-process supervision of human genetic resources project and pay more attention to the management of investigator initiated clinical trials.

Outpatient Clinic Practice of Hospice and Palliative Care in Peking Union Medical College Hospital / 中国医学科学院学报

Objective To share the outpatient clinic practice of hospice and palliative care at the Department of Geriatrics,Peking Union Medical College Hospital.Methods We conducted a retrospective analysis on the consecutive clinic data of doctor N in Geriatric Outpatient Clinic,Peking Union Medical College Hospital from January 1,2016 to December 31,2019.The patients aged 85 years and older,as well as those with end stage malignant tumor,non-tumor dysfunction due to chronic diseases or primary diseases without effective treatment were defined as patients with palliative care need.The basic information,symptoms,consultation purposes and treatments of these patients were collected.Results Among the 2502 visits during the study period,1388 patients with palliative care needs were admitted and recorded,with an average age of(69.7±13.5)years(8-105 years),among which 73.3% were patients over 60 years old and 712(51.3%)were males.Among these patients,63.4% visited specifically to seek for palliative care service and 87.2% of the visits were due to distress caused by advanced malignant tumors.Of the 221 patients with non-tumor diseases,frailty and neurodegenerative diseases were the leading life-threating cause.Of the 5483 symptoms recorded,pain(21.2%),anorexia(13.1%),fatigue(11.6%),constipation(6.9%),insomnia(4.6%),and abdominal distension(4.6%)were the six common symptoms.In the 2502 visits,26.2% of the patients had mutiple visits,and 50.3% of the patients with multiple visits had more than three visits;38.6% of patients visited the clinic themselves,and 65.7% of visits were attended by two or more family members(including the patients).The average duration of visit was(19.6±8.5)min(2-85 min),and 13.5%,53.0%,25.6% and 7.9% of the patients completed the consultation within 10,11-20,21-30 and over 30 min,respectively.Conclusion There is strong demand of palliative care in the outpatient clinic of Department of Geriatrics in Peking Union Medical College Hospital and it is feasible to provide palliative care service for patients with serious diseases in geriatric outpatient clinics.

The evaluation of scientific research efficiency in a tertiary hospital based on Data Envelopment Analysis and Malmquist index / 中华医学科研管理杂志

Objective:To evaluate the scientific research efficiency and its change in a tertiary hospital, provide recommendations for improvement based on evaluation findings.Methods:We evaluated the scientific research efficiency of 35 disciplines in a tertiary hospital from 2015 to 2017 with BCC model of Data Envelopment Analysis and Malmquist index.Results:The number of DEA valid disciplines was 10, 16, 10 respectively. The average efficiency value from 2015 to 2017 of internal medicine, surgery department and supportive department was 0.62, 0.71, 0.74. The Total Factor Productivity of 2017, compared with 2015, was 1.30, which was mainly attributed to increase of Pure Technical Efficiency. There were 23 disciplines which efficiency increased and 12 disciplines which efficiency decreased.Conclusions:The scientific research efficiency of the tertiary hospital showed a rising trend. The efficiency of disciplines varied largely. For disciplines of DEA invalid or with downward trend, it is important to improve efficiency by improving management, cultivating talents, improving technology and increasing scientific output, and so on.

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.