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Objective:To investigate the current status of diagnosis and treatment of Helicobacter pylori ( H. pylori) infection in primary hospitals in Jiangsu Province, and to evaluate the capability of comprehensive prevention and management of H. pylori infection in the primary hospitals. Methods:From 2020 to 2022, a questionnaire survey was conducted among 430 primary hospitals, which participated in the Incubation Center Project of Primary Gastroenterology Specialty Department in Jiangsu Province. The questionnaire survey includedthe establishmment of endoscopy and department of gastroenterology, items of H. pylori detection, H. pylori treatment, eradication plans and treatment course. The questionnaire was filled by the director of the primary hospital. Descriptive analysis was used for statistical analysis. Results:A total of 413 valid questionnaires were received. Among the 413 primary hospitals, 286 (69.2%) were equipped with endoscopy centers, and 202 (48.9%) had departments of gastroenterology. In terms of diagnostic methods for H. pylori, 35.8% (148/413) of the primary hospitals did not have urea breath test equipment, of which 84 hospitals did not carry out any H. pylori testing items, 8 hospitals only had rapid urease test, 45 hospitals only had serum H. pylori antibody test, 7 hospitals had both rapid urease test and serum H. pylori antibody test, and 4 hospitals had fecal H. pylori antigen test. In terms of therapeutic drugs, all the hospitals could provide proton pump inhibitors, and 82.8% (342/413) of the hospitals had bismuth agents. According to diagnosis and treatment guideline for H. pylori infection at the primary care, 7 combinations of two antibiotics were recommended. A total of 14 (3.4%) hospitals could provide all the combinations, 369 (89.3%)hospitals could provide 2 to 6 combinations, 20(4.8%)hospitals could provide only one combination, and 10 (2.4%) hospitals could not provide any combination. For the selection of the eradication scheme and treatment course, the bismuth-based quadruple scheme was chosen in 248 (60.0%) hospitals, 14-day course was selected in 363(87.9%) hospitals, and 14-day course of bismuth-based quadruple scheme was selected in 232 (56.2%) hospitals. Conclusion:Improving the H. pylori testing equipment in primary hospitals, preparing all types of therapeutic drugs, and improving doctors′ knowledge of diagnosis and treatment of H. pylori in are of great significance for improving the prevention and treatment efficacy of H. pylori infection at the primary hospitals.
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Background: Acute non-variceal upper gastrointestinal bleeding (ANVUGIB) is one of the most common acute and severe clinical entities. As the limited medical resource in remote regions or primary hospitals, it is necessary to explore an effective endoscopic hemostasis method in such a medical condition. Aims: To investigate the efficacy of norepinephrine injection combined with electrocoagulation under conventional endoscopy in patients with ANVUGIB. Methods: Clinical data of 123 ANVUGIB patients were collected retrospectively from January 2019 to December 2021 at the Kashgar Prefecture Second People’s Hospital. According to the endoscopic hemostasis method used initially, these patients were divided into group A (submucosal injection of norepinephrine), group B (electrocoagulation), group C (clip hemostasis) and group D (direct norepinephrine injection combined with electrocoagulation). The success rate of immediate hemostasis, operation time, rebleeding rate within 72 hours, and rate of transfer to surgery were compared between the four groups. Furthermore, the relationship between visual field during hemostasis and success of immediate hemostasis was analyzed. Results: In group D, all patients achieved success immediate hemostasis, the success rate (100%) was significantly higher than that in group A, group B, and group C (all P0.05). In patients treated with combined hemostasis, including initial combination strategy and failed cases transferred to combination strategy, a clear endoscopic visual field could be obtained in 94.2% of the cases, and the success rate of immediate hemostasis was 98.1%. Conclusions: Submucosal injection of norepinephrine combined with electrocoagulation under conventional endoscopy has a higher immediate hemostasis rate with lower rates of rebleeding and surgical transfer in ANVUGIB patients. This strategy is worthy for popularizing in remote regions and primary hospitals.
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PURPOSE@#It is a challenge for the primary hospitals to manage multiple trauma patients. In this article, we explored the advantage of establishing a surgical intensive care unit (SICU) predominant by cardiothoracic surgeons in the early management of multiple trauma.@*METHODS@#This was a retrospective study and patients with multiple trauma in our hospital were collected and divided into two groups, based on time period and treat modes: group A (retrospective observation group) where patients were treated with the traditional treatment mode from January 2017 to December 2017 and group B (study group) where patients were treated in the SICU predominant by cardiothoracic surgeons from January 2018 to December 2018. Clinical data including demographics, injury severity score (ISS), causes of injury, time intervals from reception to entering SICU or operating room and mortality three days after injuries were collected. Data were analyzed by SPSS 20.0 software. Categorical variables were presented as number and/or frequency and continuous variables as mean ± SD.@*RESULTS@#Altogether 406 patients were included in this study, including 217 patients in group A and 189 patients in group B. General data between the two groups revealed no significant difference: mean age (years) (35.51 ± 12.97 vs. 33.62 ± 13.61, p = 0.631), gender distribution (mean/female, 130/87 vs. 116/73, p = 0.589) and ISS (15.92 ± 7.95 vs. 16.16 ± 6.89, p = 0.698). Fall from height were the dominant mechanism of injury, with 135 cases in group A (71.4%) and 121 cases in group B (55.8%), followed by traffic accidents. Injury mechanism showed no significant differences between two groups (p = 1.256). Introduction of the SICU significantly improved the care of trauma patients, regarding speed and mortality. Time intervals between reception and entering SICU or operating room was (108.23 ± 6.72) min and (45.67 ± 7.96) min in group A and B, respectively (p = 0.001). Mortality three days after injuries was 13.89% and 5.53% in group A and B, respectively (p = 0.005).@*CONCLUSION@#Establishing a SICU predominant by cardiothoracic surgeons can reduce the early mortality rates in multiple trauma patients.
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Objective To investigate the effect and feasibility of problem-based learning teaching model in case discussion and its influence on the cultivation of medical students' practical ability in primary hospitals under the guidance of the synergy of medical education. Methods Interns from this hospital of the year 2017 were chosen as subjects. Those who were organized by science and teaching department with PBL model in case discussion were observation group, while those who were organized in traditional case discussion by clinical departments were control group. Questionnaires were filled in and effects between two groups were compared. Results In both the cognitive and affective domain, PBL teaching group scored higher compared with traditional teaching group (P=0.000). Conclusion Under the current situation, carry-ing out PBL teaching model has certain feasibility and practical significance in primary hospitals and is more suitable for the development of medical cooperation between colleges and hospitals.
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Objective To explore initial application of network in remote consultation system in the manage-ment of obstetrics in primary hospital.Methods Data were collected in questionnaire survey,a total of 54 hospitals in Jiangsu province were involved.The situation of remote consultation and perceive of pregnant and puerpera in primary hospital were investigated to establish an independent cyber in remote consultation system.Results The demand for remote consultation at all levels of hospital was huge(79.63%),there was no significant difference (P >0.05).Third class hospital has been widely carried out the remote medical consultation service,about 85.37% of the level II hospi-tals had not yet been carried out,which did not have the conditions accounted for 68.29%,the difference was statisti-cally significant(P <0.01).There was a significant difference between the demand and the approval degree of the pri-mary hospital in the remote consultation(P <0.01),high school or above,technical staff and urban pregnant women needed the most pressing,high degree of recognition.Conclusion The primary hospital medical personnel profession-al quality was the important factor that affected the use of remote consultation.The corresponding point,independent network creation and combined with face to face diagnosis were needed in the performance of remote consultation.Suc-cessful opening of the remote consultation system,improved the quality of the diagnosis and treatment,promoted the academic exchange between regions.It was conducive to the management of the high -risk pregnancy and should be actively promoted and applied.
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Objective Investigation and analysis the innovation ability and its influencing factors about graduates in primary hospitals,discuss corresponding measurements to enhance their innovation capacities.Methods A total number of l17master students and leadership persons at related institutions in primary hospitalsfrom particular district of China were surveyed with self-made questionnaires.Transformational Leadership Questionnaire,Organizational Commitment Questionnaire,and Multi dimensional Innovative Behavior Scale were used to investigate both personal and environmental factors that maybe influential for further discussion of possible improvement strategies.Results Among the 117 master students,having a capacity for independent innovationand getting partial achievements is only 6.84％;that canactively participatingin but temporarily have notborne fruit is 11.96％,24.78％ of which are passively finishingthe task of writing papersunder the request of the hospital,high up to 56.41％ are do not have any achievements in technology innovation yet.In the meanwhile,63.16％ administrators,compared to 36.84％,have negative attitudes to the graduate students.In terms of influence factors,that closely related to creative production,creative execution are identity,virtue and the vision of transformational leadership behavior motivation,charismatic leadership,individualized consideration,and affective commitment,ideal commitment,economic commitment,opportunity commitment of organizational commitment,P＜0.05,the difference has statistically significant;but not correlative with normative commitment,P＞0.05,the difference have not statistically significant.Conclusions The innovation capacityof master students working in primary hospitals is seriously insufficient,and its influence factors are closely related to both personal and environmental factors.Targeted innovation knowledge training and appropriate incentive mechanism are effective measurements to improve their innovation capacity.The necessary condition of facilitiesis thepremise and guarantee for them to carry out the science and technology innovation.
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Objective:To systematically evaluate the influence of the implementation of essential drug policy ( EDP) on prescrip-tion use rate of antibiotics in primary hospitals. Methods:Based on CNKI, Wanfang and VIP of China journal databases, all litera-tures were adopted including the data of the prescription use rate of antibiotics in primary hospitals. RevMan5. 3 and Stata 12. 0 soft-ware were used to conduct the Meta analysis. Results:Totally 43 literatures were included in the study according to the evaluation se-lection criteria. After the implementation of EDP, the prescription use rate of antibiotics in primary hospitals was decreased, and com-pared with that before the implementation of EDP, the risk difference value was significant [RD= -0. 03,95%CI( -0. 04,-0. 03), P<0. 000 01], while the use rate was still high (46. 16%). The result of Egger’s test indicated the publication bias of the 43 litera-tures was not significant (P=0. 571). However, there was high heterogeneity(I2 =94%,P<0. 000 01)among the different studies. Based on the classification of hospital type and different areas, the results of sub-group analysis showed the differences of study methods in the literatures and regional implementation measures of EDP contributed to the high heterogeneity among the different studies. Con-clusion:In order to reduce the heterogeneity of studies, a unified evaluation criteria for the research quality of the cross-section survey should be established. And special policies related to EDP should be taken to effectively decrease the use rate of antibiotics in primary hospitals.
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Objective To discuss on the management of the medicines in ward pharmacy of primary hospitals and ex-plore effective measures to improve the quality of medicines management .Methods Based on the real situation , managing the quantity of medicines in inpatient pharmacy, including the setting of the reasonable quantity, the procedures of storing and de-livering, the quality control on the general medicines and the management of high -risk medicines, to improve the quality of management of the medicines in ward pharmacy .Conclusion The use of medicines in ward pharmacy of primary hospitals is becoming more and more standardized and rationalized by strengthening the management of the medicines in inpatient pharmacy .
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The medical disputes in the primary hospitals increase year by year , and the practical experience at the grass-roots level during 1999 and 2013 showed the medical disputes had various reasons .For primary hospi-tals, the reasons included incomplete reform and management , unsuitable technical level of medical staff , inappropri-ate physician -patient communication and medical service , disunity within the hospital , lack of self -protection awareness;For patients, the reasons included the high expectations of medical service , non-compliance with medi-cal workers, poor economic conditions , week legal awareness;and some reasons from the society , media, etc.To ef-fectively alleviate the tension of physician -patient relationship and build a harmonious medical environment , the pri-mary hospitals need to strengthen the internal management , improve the comprehensive quality of medical staff , en-hance the physician -patient communication , improve self-protection awareness , and establish a good image of pri-mary hospitals.
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ObjectiveTo explore the determinants of average length of stay of three county hospitals and eleven countryside hospitals of Xinjiang province.MethodsRelative data of the county and the countryside hospitals from 2009 to 2010 were collected,and descriptive analysis and rank sum test were employed to explore the determinants of average length of stay.ResultsThe average length of stay of the county hospital was longer than the countryside hospital,the average length of stay had significant differences between the gender,age,and the disease classfication.ConclusionThe average length of stay of the county hospitals and countryside hospitals had difference significantly.