Hospitais de Cidades Pequenas: inserção e pactuação no Sistema Único de Saúde (SUS) / Small Towns Hospitals: insertion and agreement in the Brazilian Unified Health System

RESUMO: Importância do problema: É indiscutível a importância do hospital na organização no Sistema Único de Saúde (SUS). Os hospitais com 50 leitos ou menos, também chamados de hospitais de pequeno porte (HPP) são essenciais para a construção das redes de atenção à saúde (RAS) considerando sua capilaridade no sistema. Objetivo: Descrever a caracterização dos hospitais de pequeno porte e sua adequação à política vigente. Método: Trata-se de um estudo transversal, descritivo, realizado a partir de dados secundários obtidos de bases de dados nacionais: Cadastro Nacional de Estabelecimentos de Saúde (CNES-MS), Sistema de Informações Hospitalares (SIH/SUS) e o sistema de registro de dados hospitalares da Regional de Saúde. O estudo foi realizado em uma região de saúde localizada no norte do Paraná, Brasil. Resultados: Neste estudo, 100% dos hospitais em cidades pequenas da 17ª Regional de Saúde do Paraná são de pequeno porte. A oferta de leitos atende à estabelecida pela portaria do Ministério da Saúde n° 1.101/2002. Observou-se a extrema ociosidade da capacidade instalada, centros cirúrgicos inativos e baixíssima ocupação dos leitos hospitalares. Conclusão: Conclui-se que a forma de pactuação/contratualização isolada de cada hospital não surtiu os efeitos desejados pela Política Nacional de HPP (PNHPP). Sugere-se que uma nova vinculação ocorra de forma regionalizada e que se criem um sistema unificado de gestão. (AU)

ABSTRACT: Importance of the problem: The importance of the hospital in the organization of the Brazilian Unified Health System (UHS)is indisputable. Hospitals with 50 beds or fewer, also called small hospitals are essential for building health care networks considering their capillarity in the system. Objective: Describing the characterization of small hospitals and their adequacy to current policy and confirm the results presented so far in the literature. Method: This is a cross-sectional, descriptive study based on secondary data obtained from the national databases: National Registry of Health Establishments, Hospital Information System, and registry of data of the Regional of Health. The study was conducted in a health region located in northern Paraná, Brazil. Results: In this study, more than 90% of the hospitals in towns of the 17th Regional of Health of Paraná are small. The supply of beds meets the guidelines of the Ministry of Health n. 1,101/2002. It was observed the extreme idleness of facilities, inactive surgical centers, and low occupation of hospital beds. Conclusion: It is concluded that the form of agreement isolated from each hospital did not have the desired effects by national small hospital policy. It is suggested that a new connection occurs regionally and that a unified management system might be created. (AU)

The Effects of Operating Room Nurses' Perceptions of Organizational Health, Safety Climate, and the Nursing Working Environment on Engagement in Patient Safety Management Activities / 산업간호학회지

PURPOSE: This study aimed to examine the relationship between organizational health (OH), safety climate (SC), the nursing working environment (NWE), and engagement in patient safety management activities (PSMA) among operating room nurses and identify the factors that predict engagement in PSMA.METHODS: From August 10th to 25th, 2018, 176 operating room nurses who were working in tertiary and general hospitals responded to a structured questionnaire. Using SPSS/WIN 25.0, the collected data were subjected to independent-samples t-test, one-way analysis of variance, Scheffé test, and Pearson's correlational and multiple stepwise regression analyses.RESULTS: OH and SC were significantly correlated with engagement in PSMA. The factors that predicted engagement in PSMA were OH, NWE, participation in accreditation, years of work experience, and hospital size; together, they explained 17% of the variance in engagement in PSMA.CONCLUSION: This study revealed that OH has a significant influence on engagement in PSMA among operating room nurses. Therefore, hospitals should aim to create healthy working environments to promote engagement in PSMA among operating room nurses, actively delegate responsibilities to increase their level of participation in accreditation, and implement strategies that maintain high levels of nurse retention.

Comparison of Mortality Rate according to Hospital Level among Patients with Poisoning Based on Korean Health Insurance and Assessment Service

PURPOSE: Mortality rate in the health services research field is frequently considered as a proxy for measuring healthcare quality. We compared the mortality rate and hospitalization levels among patients with poisoning. METHODS: A population-based study of hospital size and level based on the Korean health insurance and assessment service was conducted to identify the impact of hospital level on patient mortality. RESULTS: We analyzed a total of 16,416 patients, of which 7,607 were from tertiary hospitals, 8,490 were from general hospitals, and 319 were from hospitals. The highest mortality rate of diagnosis regarding poisoning was T60.31 (other herbicides and fungicides, 16%), followed by T60.0 (organophosphate and carbamate insecticides, 12.7%). There was no statistical difference in mortality among hospital levels for gender. Among age groups, tertiary hospitals had lower mortality than general hospitals and hospitals for patients aged more than 70 years (11.9% mortality at tertiary vs 14.2% at general and 23% at hospital; p=0.003, adjusted z score=−6.9), general hospitals had lower mortality than tertiary hospitals and hospitals for patients aged 18 to 29 (0.6% at general vs 2.4% at tertiary and 3.7% at hospital; p=0.01, adjusted z score=−4.3), and hospitals had lower mortality than tertiary hospitals and general hospitals for patients between 50 and 59 years of age (0% at hospital vs 6.4% at general and 8.3% at tertiary; p=0.004). CONCLUSION: Overall, there was no significant difference between mortality and hospital level among poisoned patients. However, to establish an efficient treatment system for patients with poisoning, further studies will be needed to identify the role of each facility according to hospital level.

Interstitial Lung Disease and Lung Cancer Development: A 5-Year Nationwide Population-Based Study / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: In this nationwide 5-year longitudinal population-based study, we aimed at investigating the incidence of lung cancer among patients with interstitial lung disease. MATERIALS AND METHODS: Data was collected from the Korean National Health Insurance Research Database from 49,773,195 Korean residents in 2009. Thirteen thousand six hundred and sixty-six patients with interstitial lung disease diagnosed January-December 2009. The end of follow-up was June 30, 2014. Up to four matching chronic obstructive pulmonary disease controls were selected to compare the lung cancer high-risk group based on age, sex, diagnosis date (within 30 days), and hospital size. The number of patients with newly developed lung cancer was determined. RESULTS: The incidences of lung cancer were 126.98, 156.62, and 370.38 cases per 10,000 person-years (2,732, 809, and 967 cases of cancer, respectively) in the chronic obstructive pulmonary disease, interstitial lung disease, and chronic obstructive pulmonary disease with interstitial lung disease groups, respectively. Of the 879 patients with idiopathic pulmonary fibrosis, 112 developed lung cancer (incidence, 381.00 cases per 10,000 person-years). CONCLUSION: Incidence of lung cancer among patients with interstitial lung disease was high. Interstitial lung diseases have a high potential for developing into lung cancer, even when concurrent with chronic obstructive pulmonary disease.

Differences among Ophthalmology Patients Referred to Tertiary Medical Centers according to Referral Hospital

PURPOSE: This study aimed to investigate the diagnosis and severity of patients who were referred to tertiary medical centers according to the type and function of the referral hospitals. METHODS: First-visit patients referred from July 2015 to June 2016 were retrospectively reviewed with regard to referral hospital, final diagnosis, treatment necessity, and medical fees for the six months after their first hospital visit. Based on these data, differences in type and function of medical institution were examined. RESULTS: In a comparison of hospitals according to their number of beds, clinics, hospitals and, tertiary hospitals had no differences in the ratio of patients who needed treatment (p = 0.075) and their medical fees over six months (p = 0.372). When hospitals were classified by functional capability in terms of doctors' medical specialty, increasing ratios of patients requiring medical treatment (p < 0.001) and medical fees for six months (p < 0.001) were found in the order of non-eye specialists, eye specialists, and eye specialists in trainee hospital. CONCLUSIONS: Efficient healthcare delivery systems should classify medical institutions by functionality capability based on medical specialties rather than hospital size according to the number of beds.

The Status of Infection Control Nurses and Factors Affecting Infection Control Activities in Healthcare Facilities with more than 150 Beds in 2016 in KOREA / 임상간호연구

PURPOSE: The purpose of this study was to describe the status of infection control nurses (ICNs) and their activities, and to identify the factors affecting the level of infection control activities. Methods: Data were collected from 199 hospitals from June 24 to July 26, 2016. The structured questionnaires included status of infection control nurses, type and level of infection control activities. METHODS: Data were collected from 199 hospitals from June 24 to July 26, 2016. The structured questionnaires included status of infection control nurses, type and level of infection control activities. RESULTS: Most participating hospital were advanced general hospital (20.1%) and general hospital (67.8%). Among the hospitals, 86.4% had an infection control department (ICD). The average hospital work experience of ICNs was 14.62 years, and their average infection control career was for 4.94 years. Among the ICNs, 85.6% worked in full time and the average number of beds per ICN was 311.21. There were significant differences in the existence of ICD, infection control activities including surveillance, outbreak investigation, negative pressure room, hand hygiene monitoring, disinfection, and sterilization according to hospital size. The level of infection control activities was higher with more number of ICNs, ICN employment as full time, and healthcare institution accreditation status. The explanatory power was 37.5%. CONCLUSION: These results of this study which reflect infection control status of healthcare facilities with more than 150 beds in 2016 will provide baseline data to establish infection control system in small to medium sized hospitals after the Middle East Respiratory Syndrome outbreak in 2015.

Does Hospital Volume Really Affect the Surgical and Oncological Outcomes of Gastric Cancer in Korea?

PURPOSE: The significance of hospital volume remains inconsistent and controversial. In particular, few studies have examined whether hospital volume is associated with the outcome of gastrectomy for gastric cancer in East Asia. This study examined the effect of hospital volume on the short-term surgical and long-term oncological outcomes of patients undergoing curative gastrectomy for gastric cancer. MATERIALS AND METHODS: Between 2009 and 2011, 1,561 patients underwent curative gastrectomy for gastric cancer at Seoul St. Mary's Hospital (n=1,322) and Bucheon St. Mary's Hospital (n=239). We defined Seoul St. Mary's Hospital as a high-volume center and Bucheon St. Mary's Hospital as a low-volume center. RESULTS: The extent of resection, rate of combined resection, tumor stage, operating time, and hospital stay did not differ significantly between the 2 hospitals. In addition, the hospital volume was not significantly associated with the 30-day morbidity and mortality. When the overall and disease-free survival rates of the patients were stratified according to stage, hospital volume was not significantly associated with prognosis at any stage. CONCLUSIONS: Hospital volume might not be a decisive factor with respect to the surgical and oncological outcomes of patients if well-trained surgeons perform gastrectomy for gastric cancer.

The Impact of Hospital Specialization on Length of Stay per Case and Hospital Charge per Case / 보건행정학회지

BACKGROUND: Over the last few decades, because hospitals in South Korea also have undergone dramatic changes, Korean hospitals traditionally have provided specialized health care services in the health care market. Inner Herfindahl-Hirschman Index (IHI) measures hospital caseloads based on patient proportions, independent of patient volumes. However, IHI that rely solely on patient proportions might be problematic for larger hospitals that provide a high number of diagnosis categories, as the patient proportions in each category are naturally relatively smaller in such hospitals. Therefore, recently developed novel measure, category medical specialization (CMS) is based on patient volumes as well as patient proportions. METHODS: we examine the distribution of hospital specialization score by hospital size and investigate association between each hospital specialization and length of stay per case and hospital cost per case using Korean National Health Insurance Service-cohort sample data from 2002 to 2013. RESULTS: Our results show that IHI show a decreasing trend according to the number of beds and hospital type but CMS show an increasing trend according to the number of beds and hospital type. Further, inpatients admitted at hospitals with higher IHI and CMS had a shorter length of stay per case (IHI: B=-0.104, p<0.0001; CMS: B=-0.044, p=0.001) and inpatients admitted at hospitals with higher IHI and CMS had a shorter hospital cost per case (IHI: B=-0.110, p=0.002; CMS: B=-0.118, p=<0.0001). CONCLUSION: this study may help hospital policymakers and hospital administrators to understand the effects of hospital specialization strategy on hospital performance under recent changes in the Korean health care environment.

The Effect of Mandatory Diagnosis-Related Groups Payment System / 보건행정학회지

BACKGROUND: The voluntary diagnosis-related groups (DRG)-based payment system was introduced in 2002 and the government mandated participation in the DRG for all hospitals from July 2013. The main purpose of this study is to examine the independent effect of mandatory participation in DRG on various outcomes of patients. METHODS: This study collected 1,809,948 inpatient DRG data from the Health Insurance Review and Assessment database which contains medical information for all patients for the period 2007 to 2014 and examined patient outcomes such as length of stay (LOS), total medical cost, spillover, and readmission rate according to hospital size. RESULTS: LOS of patients decreased after DRGs (large hospitals: adjusted odds ratio [aOR], 0.87; 95% confidence interval [CI], 0.78-0.97; small hospitals: aOR, 0.91; 95% CI, 0.91-0.92). The total medical cost of patients increased after DRGs (large hospitals: aOR, 1.22; 95% CI, 1.14-1.30; small hospitals: aOR, 1.22; 95% CI, 1.21-1.23). The results reveals that spillover of patients increased after DRGs (large hospitals: aOR, 1.27; 95% CI, 0.70-2.33; small hospitals: aOR, 1.18; 95% CI, 1.16-1.20). Finally, we found that readmission rates of patients decreased significantly after DRGs (large hospitals: aOR, 0.28; 95% CI, 0.26-0.29; small hospitals: aOR, 0.59; 95% CI, 0.56-0.63). CONCLUSION: The DRG payment system compared to fee-for-service payment in South Korea may be an alternative medical price policy which can reduce the LOS. However, government need to monitor inappropriate changes such as spillover increase. Since this study also is the results based on relatively simple surgery, insurer needs to compare or review bundled payment like new DRG for expansion of various inpatient-related diseases including internal medicine.

Nurse Staffing and 30-day Readmission of Chronic Obstructive Pulmonary Disease Patients: A 10-year Retrospective Study of Patient Hospitalization

PURPOSE: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity in many countries, and it has high rate of hospital readmissions due to recurrent exacerbations of the disease. Many previous studies have suggested further examination of the factors that contribute to hospital readmissions of COPD patients. However, evidence on the effects of nurse staffing by registered nurses (RNs) on the readmission of COPD patients is lacking in Korea. The aim of our study was to evaluate the effects of nurse staffing on hospital readmissions of COPD patients. METHODS: We used National Health Insurance claim data from 2002 to 2012. A total of 1,070 hospitals and 339,379 hospitalization cases were included in the analysis. We divided the number of RNs per 100 beds and the proportion of RNs on staff to one of three groups (Q1: low; Q2: moderate; Q3: high). A generalized estimating equation model was used to evaluate the associations between readmission and nurse staffing. RESULTS: A higher number of RNs was associated with lower readmission rates of 8.9% (Q2) and 7.9% (Q3) respectively. A similar effect was observed as the proportion of RNs among the total nursing staff gradually increased, resulting in lower readmission rates of 7.7% (Q2) and 8.3% (Q3). CONCLUSIONS: Our results suggest notable positive effects of nurse staffing by RNs on patient outcomes. In addition, the magnitude of impact differed between different sizes of hospitals. Thus, human resource planning to solve staffing shortages should carefully consider the qualitative aspects of the nursing staff composition.

Relationship between Organizational Culture and Workplace Bullying among Korean Nurses

PURPOSE: To identify the relationship between organizational culture and experience of workplace bullying among Korean nurses. METHODS: Participants were 298 hospital nurses in Busan, South Korea. We assessed nursing organizational culture and workplace bullying among nurses using structured questionnaires from July 1 through August 15, 2014. RESULTS: Most participants considered their organizational culture as hierarchy-oriented (45.5%), followed by relation-oriented (36.0%), innovation-oriented (10.4%), and task-oriented (8.1%). According to the operational bullying criteria, the prevalence of workplace bullying was 15.8%. A multivariate logistic regression analysis revealed that the odds of being a victim of bullying were 2.58 times as high among nurses in a hierarchy-oriented culture as among nurses in a relation-oriented culture [95% confidence interval (1.12, 5.94)]. CONCLUSIONS: The results suggest that the types of nursing organizational culture are related to workplace bullying in Korean nurses. Further research is needed to develop interventions that can foster relationoriented cultures to prevent workplace bullying in nurses.

Development and Implementation of an Education Program for Novice Infection Control Nurses / 병원감염관리

BACKGROUND: This study was performed to improve the working competencies of novice infection control nurses (ICNs) and thereby prevent healthcare associated infection. We developed and implemented an education program and then evaluated its effectiveness. METHODS: The education program was developed by conducting a literature review and four expert group discussions. The program was implemented twice, and included 3 days of lectures and 1 day of practice in Seoul and Pusan, for 157 ICNs with less than 3 years of experience. The knowledge of the participants before and after the educational program and overall satisfaction were measured. Data were analyzed using the SPSS WIN 18.0 program. RESULTS: The education program consisted of 12 lectures and 2 practices in total. The post-program knowledge score increased to 77.99 compared to 45.91 prior to participating in the program (P<.001). The scores for overall satisfaction, knowledge acquirement, and usefulness in field practice were 9.05, 8.97, and 9.01, respectively. The overall satisfaction was higher for the practice component (9.37) than the lectures (9.00). There were significant differences in surveillance knowledge according to age (F=3.94, P=.021), hospital career (F=3.71, P=.027), hospital type (F=5.36, P=.006), and hospital size (F=6.19, P=.003); and there were significant differences in hand hygiene knowledge according to age (F=4.14, P=.018) and hospital type (F=4.84, P=.009). However, there was no difference in overall satisfaction with the program. CONCLUSION: To enhance working competencies and professionalism, education programs considering the characteristics and needs of the ICNs must be developed. Moreover, professional training courses are needed to nurture ICNs in small hospitals.

Factors Affecting Emergency Room Nurse Job in Small and Medium Sized Hospitals / 간호행정학회지

PURPOSE: The purpose of this study was to identify the job of emergency room (ER) nurses working in small and medium sized hospitals and to explore factors affecting their job. METHODS: The survey data were collected between January 2014 and May 2014 and participants were 159 nurses working in Seoul, Kyunggi, Incheon, and Chungnam in hospitals of less than 500 beds. RESULTS: The score for nurses job was 2.12/4.0, and emergency treatment (1.87/4.0) followed basic nursing (3.51/4.0) and counseling (2.32/4.0). The nursing job was significantly different depending on the age, education level, position, resident doctor(emergency medicine specialty or other) and grade of ER (regional ER or local ER). In the multiple regression, education level (beta=.18), position (beta=.24), hospital size (beta=.20), and grade of ER (beta=.21) explained 17.0% of variance in ER nurses' job in small and medium sized hospitals. CONCLUSION: The findings indicate that ER nurses in vulnerable areas do more nursing practice including emergency treatment as well as the usual independent nursing practice. Accordingly, a systematic assignment of nursing professionals is needed to reduce loading of ER nurses in small and medium sized hospitals.

Determinants of Registered Nurse Skill Mix & Staffing Level in Korea / 간호행정학회지

PURPOSE: This study was done to identify determinants of registered nurse (RN) skill mix and staffing level focused on hospital characteristics. METHODS: Data were obtained from health insurance claims data and hospital reporting system in the Health Insurance Review and Assessment Service (HIRA) for the year 2010. Data from 2,998 hospitals were analysed using t-test, ANOVA, Pearson correlation, and regression analysis. RESULTS: The RN skill mix and staffing level were positively related to hospital size and the percentage of inpatients to total patients. RN skill mix and staffing level were statistically different across regions. Including nursing aides (NA), however, there was no difference in staffing levels across regions. Medically vulnerable regions, bed operation rate, and the number of patients per doctor were also related to RN skill mix and staffing level. CONCLUSION: The statically significant determinants of RN skill mix and staffing level included hospital size, region, bed operation rate, percentage of inpatients, doctor-patient ratio. Further study needs to be done to investigate factors including RN supply and wages.

The Effects of Self-efficacy and Collective Efficacy on Job Satisfaction and Organizational Commitment of Nurses / 한국직업건강간호학회지

PURPOSE: The purpose of this study was to investigate the relationships among self-efficacy, collective efficacy, job satisfaction, and organizational commitment of nurses working in general hospitals. METHODS: Data were collected from 239 nurses working in five general hospitals of a local area by self-reported questionnaires. The collected data were analyzed with descriptive statistics, t-test, ANOVA, Pearson's correlation, and hierarchial multiple regression. RESULTS: Self-efficacy, collective efficacy, job satisfaction, and organizational commitment showed significantly positive correlations. Hierarchial multiple regression analysis showed that self-efficacy was the main factor of affecting job satisfaction, which explained 14.3% of the variance for the nurses' job satisfaction together with collective efficacy and weekly working time. In addition, the primary factor of affecting organization commitment was self-efficacy, which accounted for 17.2% of the variance for the nurses' organizational commitment together with hospital size and shift work. CONCLUSION: Self-efficacy and nursing working condition such as working time or hospital size contributed to the job satisfaction and organizational commitment and collective efficacy contributed to the job satisfaction. Therefore, the strategies for improving self and collective efficacy should be considered. Further study is also needed to investigate the concept of collective efficacy and its' measurement, and the relationship between collective efficacy and organizational commitment.

Mediating Effect of Challenging Work in the Relationship between Cognitive Style and Creative Action in Clinical Nurses / 간호행정학회지

PURPOSE: The purpose of this study was to identify the relationship among cognitive style, creative action, and challenging work and then determine whether challenging work has a mediating effect between cognitive style and creative action. METHODS: Data were collected from a convenience sample of 275 clinical nurses who graduated from 3-year nursing schools and worked in hospitals in Seoul or Kyungki Province. The questionnaire included measurements of cognitive style, creative action and challenging work. Data were analyzed using descriptive statistics, correlation, T-test, ANOVA, Duncan test, and hierarchical multiple regression. RESULTS: Mean scores for cognitive style, creative style, and challenging work were 3.28+/-0.42, 3.22+/-0.57, 3.40+/-0.63, respectively. Significant correlations were found between cognitive style and challenging work, cognitive style and creative action, and challenging work and creative action. Cognitive style was significantly different according to years in clinical career, and in hospital size. Challenging work was significantly different according to age and position. Creative action was significantly different according to years in clinical career. Finally challenging work had a mediating effect between cognitive style and creative action. CONCLUSION: Findings from this study provide a comprehensive understanding of challenging work for clinical nurses and indicate related factors and importance.

A Comparative Study on Nursing Practice Environment, Professionalism, and Job Satisfaction according to Hospital Size / 간호행정학회지

PURPOSE: This study was conducted to investigate and compare the characteristics and relations of nursing practice environment, professionalism and job satisfaction among nurses in general hospitals according to hospital size. METHODS: The participants included 314 staff and charge nurses who were working in the general medical/surgical nursing units in one large hospital, three medium sized hospitals, and four small hospitals. Data collected through using self-report questionnaire were analyzed using the SPSS and SAS statistical programs. RESULTS: Nursing practice environment and job satisfaction had significant differences according to hospital size. Both of these scales were highest for medium hospitals and lowest for small hospitals. For all hospital sizes there were positive correlations between each of the variables. Multiple regression analysis showed that both nursing practice environment and job satisfaction were affected by hospital size, but professionalism was not. CONCLUSION: The results of this study indicate that nursing practice environment and job satisfaction vary with the size of the hospital. Therefore, further study is necessary to identify the work environment variables of nurses for performance management and to implement appropriate policies.

Burnout and labour aspects in the nursing teams at two medium-sized hospitals / Burnout e os aspectos laborais na equipe de enfermagem de dois hospitais de médio porte / Burnout y aspectos laborales del personal de enfermería de dos hospitales de medio portea

PURPOSE: The aim of this study is to identify the occurrence of Burnout Syndrome (BS) and assess its relationship with different labour-related aspects, among nursing professionals at two medium-sizes hospitals in the city of Cáceres. METHOD: This is a transversal and descriptive study, with a sample totalling 141 subjects. As an instrument of research, we used a questionnaire for the limitation of labour-related aspects, with the addition of the Maslach Burnout Inventory (MBI). RESULTS: Out of the 141 professional people considered, 13 had BS, according to the MBI. In relation to the different labour aspects, the professional people most affected were those with: work regime based on pay by the day, a working week of 30 hours, regularly hired, with double employment, lower graduation period, less time spent at the unit, and active in the administrative segment. CONCLUSIONS: Hence, there was the demonstration of the presence of BS within the sample, showing the need for the proposal of organisational changes within the working environment so as to reduce these factors and their interference on the health of the worker.

OBJETIVO: identificar a incidência da Síndrome de Burnout (SB) e avaliar sua relação com os aspectos laborais, em profissionais de enfermagem de dois hospitais de médio porte de Cáceres, MT. MÉTODO: trata-se de estudo descritivo, transversal, com amostra de 141 sujeitos. Como instrumento de pesquisa utilizou-se um questionário para o delineamento dos aspectos laborais, acrescido do Maslach Burnout Inventory (MBI). RESULTADOS: dos 141 profissionais, 13 apresentaram SB, segundo o MBI. Em relação aos aspectos laborais, os profissionais mais acometidos foram aqueles com regime de trabalho diarista, 30 horas semanais de serviço, contratado, duplo emprego, menor tempo de formação, pouco tempo na unidade e atuantes no setor administrativo. CONCLUSÕES: logo, demonstrou-se a presença da SB na amostra, revelando necessidade de se propor mudanças organizacionais no ambiente de trabalho, a fim de diminuir a interferência desses fatores na saúde do trabalhador.

OBJETIVO: Identificar la incidencia de síndrome de Burnout (BS) y evaluar su relación con los aspectos laborales, personal de enfermería de dos hospitales de medio portea de Cáceres. MÉTODO: Se trata de un estudio descriptivo, de corte transversal de la muestra de 141 sujetos. Como instrumento de investigación se utilizó un cuestionario para el delineamiento de los aspectos laborales, aumentando del Maslach Burnout Inventory (MBI). RESULTADOS: De los 141 profesionales, 13 presentaron SB según MBI. Con relación con los aspectos laborales los profesionales más acometidos son aquéllos con: régimen de trabajo diarista, 30 horas semanales de servicio, contratado, doble empleo, menor tiempo formación, poco tiempo en la unidad y actuación en el sector administrativo. CONCLUSIONES:Luego, se demostró la presencia de SB en la muestra, revelando necesidad de proponerse cambios organizacionales en el ambiente de trabajo a fin de apocar estos factores interfieren en la salud del trabajador.

Structure of Intensive Care Unit and Clinical Outcomes in Critically Ill Patients with Influenza A/H1N1 2009 / 대한구급학회지

BACKGROUND: During 2009 pandemic period, many Koreans were infected and admitted with Influenza A/H1N1. The primary aim of this study was to evaluate whether the structures of an intensive care unit (ICU) were associated with the outcomes of critically ill patients. METHODS: This retrospective observational study examined critically ill adult patients with influenza A/H1N1, who were admitted to 24 hospitals in Korea, from September 2009 to February 2010. We collected data of ICU structure, patients and 90 days mortality. Univariate and multivariate logistic regression analysis, with backward elimination, were performed to determine the most significant risk factors. RESULTS: Of the 239 patients, mortality of 90 days was 43%. Acute physiology and chronic health evaluation (APACHE) II score (p < 0.001), sequential organ failure assessment (SOFA) score (p < 0.0001), nurse to beds ratio (p = 0.039) and presence of intensivist (p = 0.024) were significant risk factors of 90 days mortality. Age (p = 0.123), gender (p = 0.304), hospital size (p = 0.260), and ICU type (p = 0.409) were insignificantly associated with mortality. In a multivariate logistic regression analysis, patients with less than 6 SOFA score had significantly lower mortality, compared with those with more than 10 SOFA score (odds ratio 0.156, p < 0.0001). The presence of intensivist had significantly lower mortality, compared with the absence (odds ratio 0.496, p = 0.026). CONCLUSIONS: In critically ill patients with influenza A/H1N1, the severity of the illness and presence of intensivist might be associated with 90 days mortality.

Analysis of the design and renovation of mid-sized hospital's local area network / 中国医疗器械杂志

To address several hospital network issues, this paper discusses the overall plan, design and renovation of hospital's Local Area Network, making full use of existing network facilities. The techniques, such as Physical Separation of Internal and External Network, HSRP, OSPF, All-Routers Networking Model, etc., create features of extensibility, manageability, high safety, stability and so on to the overall network, and provide a reliable network platform to the function of the information systems.