Establishment and application of medical quality evaluation indicator system in clinical departments of a general hospital / 现代医院

This paper introduces the construction and application of the medical quality evaluation indicator system in clinical departments of a large general hospital.It describes the indicator system's constitution and score setting,summarize the characteristics and application practice of the assessment system,and proposes some ideas for the following improvement,which in order to provide some reference for other hospitals.

The diameter of the normal extrahepatic bile duct among patients diagnosed with cholecystolithiasis managed at the Philippine General Hospital

Background and Objective@#Understanding the normal anatomy and size of the extrahepatic biliary tree is vital for surgeons to make informed decisions regarding the necessity of additional procedures beyond cholecystectomy. The extrahepatic bile duct (EHBD) comprises the common hepatic duct (CHD) and the common bile duct (CBD), with the former formed by the convergence of the right and left hepatic ducts and the latter extending from the CHD to the duodenum. A normal diameter is indicative of the absence of any signs of obstruction in the EHBD, and the determination of the average range for these ducts are essential for identifying pathologies that may require further surgical intervention. Cholecystolithiasis is a common condition managed at the Philippine General Hospital (PGH). Trans-abdominal ultrasonography is frequently utilized to diagnose cholecystolithiasis, and it can also be used to determine the size of the common bile duct. Knowledge of the normal CBD diameter aids clinicians in distinguishing obstructed bile ducts from normal ones, prompting further diagnostic tests for improved patient management. However, there is limited data on the average diameter of the CBD among Filipino patients with this condition. The study aimed to determine the mean diameter of the common bile duct and common hepatic duct among patients diagnosed with cholecystolithiasis with no signs of obstruction in the EHBD managed at the Philippine General Hospital.@*Methods@#This prospective cross-sectional study included 80 patients who underwent cholecystectomy with intraoperative cholangiography. The CBD and CHD diameters were measured using intraoperative ultrasonography, and the data were analyzed using descriptive statistics and independent t-test.@*Results@#The mean diameter of the CBD was 5.17 mm, with a range of 2.7-10 mm (1.41) mm. The mean diameter of the CHD was 4.71 mm, with a range of 2.3- 10 mm (1.59) mm. There was no significant difference in the CBD and CHD diameters between male and female patients, and across different age groups.@*Conclusion@#In patients with cholecystolithiasis managed at the PGH, the mean diameter of the CBD and the CHD was 5.17 mm and 4.71 mm, respectively, with no significant difference between genders and age groups. The mean diameter of the CBD among Filipino patients with cholecystolithiasis is similar to those reported in other countries. These findings may have clinical implications for the management of patients with cholecystolithiasis, particularly in the planning of endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy. Further studies with larger sample sizes and different populations are recommended to validate these results. These findings can aid clinicians in determining the need for pre-operative Magnetic Resonance Cholangiopancreatography (MRCP) or selective intraoperative cholangiography to detect extrahepatic bile duct obstruction.

Responsibilities and influencing factors of infection control liaison nurses in general hospitals / 中国感染控制杂志

Objective To clarify the responsibilities and influencing factors of infection control liaison nurses(ICLNs)in general hospitals.Methods Relevant databases were systematically retrieved with scoping review method from establishment to March 18,2023,and the included literatures were reported standardizedly.Results A total of 36 literatures were included in the analysis.Responsibilities of ICLNs included admittance criteria,selec-tion methods,and job responsibilities.Influencing factors of ICLNs included training,empowerment,performance evaluation,continuous improvement measures,and personnel allocation.After the establishment of ICLNs,inci-dence of healthcare-associated infection and detection rate of multidrug-resistant organisms were reduced,compli-ance rate of health care workers'hand hygiene and monitoring rate of hospital environment were improved,and the cleaning and disinfection of hospital environment was standardized.Conclusion ICLNs play a role in preventing and controlling the occurrence of healthcare-associated infection.The management and application should be further standardized and improved,the effectiveness of ICLNs needs to be thoroughly studied,so as to promote the deve-lopment of ICLNs,and improve the quality of healthcare-associated infection management.

Status Analysis of Unplanned Reoperation in Cardiac Surgery Department of a Provincial Grade A Tertiary General Hospital / 中国医院管理

Objective To analyze the current situation of unplanned reoperation in cardiac surgery and to discuss the management measures of unplanned reoperation.Methods The information of patients undergoing cardiac surgery in a class A tertiary comprehensive hospital during 2018-2022 was collected to analyze the incidence of unplanned reoperation,major ca uses,disease types,surgica l moda lities and Complications.Results A tota l of 3902 patients underwent surgery,of whom 73(1.87%)underwent unplanned reoperation.The main cause of unplanned reoperation was bleeding(50%).The disease types with the highest unplanned reoperation composition ratio were coronary heart disease(38.4%),and the disease types with the highest incidence were dilated cardiomyopathy(11.1%).The average hospitalization cost,the average length of hospitalization,mortality rate and medical dispute rate of patients who had unplanned reoperation were significantly higher than those who did not have unplanned reoperation,the difference was statistically significant(P=0.001).Conclusion The hospital should strengthen the perioperative management of cardiac surgery,focus on supervising disease types and surgical modalities with high incidence of unplanned reoperation,and strictly implement the system of operation classification and the system of reporting unplanned reoperation to ensure the quality of patient surgery.

Investigation of medical humanistic practice ability of nurses and factors affecting their practices: a questionnaire-based analysis of 1196 cases in a general hospital in Hunan Province / 南方医科大学学报

OBJECTIVE@#To investigate humanistic practice ability of nurses in a general hospital in Hunan Province and analyze the factors affecting their practices to provide evidence for interventions to improve humanistic practice ability of the nurses.@*METHODS@#A total of 1196 nurses were surveyed using a self-designed questionnaire and a nurse humanistic practice ability assessment scale questionnaire for assessment of their abilities for humanistic care practice, psychological adjustment, interpersonal communication, self-management, ethics and legal practice. Univariate and multivariate analyses were performed for analysis of the factors affecting the practice abilities of the nurses.@*RESULTS@#The total score of humanistic practice ability of the 1196 nurses was 105.69±16.45 (the full score of the scale was 130), and the scores of humanistic care practice ability, psychological adjustment ability, interpersonal communication ability, self-management ability, ethics and legal practice ability were 40.95±6.46, 16.41±2.66, 16.41±2.66, 11.32±2.05 and 12.43±2.00, respectively. Univariate analysis and multiple linear regression analysis showed that gender (P=0.033), age (P < 0.001), department (P=0.015), working years (P < 0.001), professional title (P < 0.001), first academic degree (P < 0.001), highest academic degree (P < 0.001), family location (P=0.010), marital status (P=0.023), number of patients to care for (P=0.022), number of children (P=0.001), previous humanities related training (P < 0.001), training times (P < 0.001), and care received from family members (P < 0.001) and colleagues (P < 0.001) were all the factors affecting humanistic practice ability of the nurses. Among these factors, age, working in department of obstetrics and gynecology and emergency department, professional title, humanities training, and care from family and colleagues explained 20.7% of the variance.@*CONCLUSION@#The humanistic practice ability of nurses in this general hospital is above the average level, but their self-management ability needs to be improved. Intervention measures should be implemented to improve the nurses' humanistic practice ability including more attentions to the key groups and departments, strengthening the training of humanistic practice ability, and improving the promotion assessment system.

The effect of the COVID-19 pandemic on procedures performed by fellows of the Vitreo-Retina Training Program at the Philippine General Hospital

BACKGROUND@#The COVID-19 pandemic has affected ophthalmology training. The Vitreo-Retina Training Program extended the training periods of its trainees in anticipation of a drop in surgical cases during the pandemic to make up for the expected drop.@*OBJECTIVE@#This study aimed to determine the effect of the COVID-19 pandemic on the Vitreo-Retinal Fellowship Program at the Philippine General Hospital (PGH), specifically the number of procedures performed by the Vitreo-Retina Fellows before and during the pandemic and their compliance with the Vitreo-Retina Society of the Philippines (VRSP) standards.@*METHODOLOGY@#This is a document review of vitreo-retinal procedures done at the Department of Ophthalmology and Visual Sciences of the PGH from January 1, 2017, to December 31, 2021.@*RESULT@#During the COVID-19 pandemic in 2020, there was a drop in the number of procedures performed by both the first year and second year vitreo-retina fellows. Despite the drop in numbers, the first year vitreo- retina fellows were still in compliance with the VRSP-recommended number of procedures. The second year vitreo-retina fellows, on the other hand, were not able to comply with the recommended numbers by the VRSP. The extension year allowed the second year fellows to do more procedures and comply with the recommended numbers of pars plana vitrectomy only.@*CONCLUSION@#There was a drop in the vitreo-retinal procedures during the COVID-19 pandemic. The second- year fellows were the most affected with the decrease in the number of surgical cases.

Perspectives on the use of telegenetics services in the Philippines

@#The Philippines is a densely populated nation faced with multiple challenges in the healthcare field given its geographic, cultural, and socioeconomic barriers. Due to the geographic limitations of medical services in the country, many patients must travel a great distance to referral centers. This was further exacerbated by the Coronavirus disease 2019 (COVID-19) pandemic, which spread across the world and upended lives. This pandemic triggered a public health crisis that impacted healthcare systems, healthcare workers, and communities worldwide. It compounded current difficulties with the provision and accessibility of medical services, necessitating the employment of alternative methods of providing health coverage. As a result, advanced technological methods for patient diagnosis, monitoring, treatment, and counseling were rapidly implemented.1 Interest in these technological advances began prior to the COVID-19 pandemic, though primarily in developed countries. However, during this global outbreak, telehealth practices – which refer to online health care services provided by all health care professions – have seen a rapid increase in popularity.2,3 Telehealth was brought to the forefront in all countries in order to surmount lockdown constraints, allow continuous provision of health care for patients, and limit exposure to health systems and health providers.4 Traditional medical education and training were likewise disrupted during this time, resulting in the incorporation of telehealth into medical education. To reduce the risks associated with more personnel in the hospital, medical students were withdrawn from clinical environments during the COVID-19 outbreak. This created an environment of uncertainty and limited clinical exposure, with concerns surrounding progression through the medical course and training program.5 Continuing medical education, which has traditionally been based on clinical knowledge and skills, now requires online technical communication skills. Innovative services were rapidly developed with health professionals embracing this new technological competence, enabling general consultation for patients, remote patient monitoring, and self-directed patient care, thereby decreasing the burden on health facilities. Digital learning platforms also provided an effective way to address the learning gaps caused by the pandemic. The restriction of “in-person” delivery of healthcare services due to the global outbreak has prompted physicians, including clinical geneticists and genetic counselors, to investigate alternative methods of providing health care to patients. A telehealth innovation for online delivery of clinical genetic and genetic counseling services is the Philippine General Hospital’s Telegenetics Service. Despite being launched in 2013 to serve genetics patients across the country, this service has since been upgraded and capitalized resulting in patient appreciation for its COVID-19 exposure prevention, increased access, and time and cost efficiency. However, the telegenetics service has its limitations.6,7 Despite the expanding scope of telehealth/telegenetics and its immediate application, issues such as data/patient privacy, organizational readiness, digital maturity, regulatory impediments, access and acceptance of the technology, geographical and digital disparities, and its integration with traditional medical services have emerged.8 Lack of a detailed physical examination is also lost in a virtual visit, with focused questions leading to fragmented, impersonal interactions. Even when restrictions were lifted, telehealth usage nonetheless remained significantly higher than it had been prior to the pandemic. This may indicate a shift in public opinion in favor of this innovative medical practice.9 With the expansion of genetic services in the country, there is now a greater need for telegenetics due to the increased demand for clinical genetic and genetic counseling expertise. Therefore, evidence on the safety and efficacy of this technology in comparison to the traditional healthcare delivery approach is required. If the technology has the potential to improve health care, we must guarantee its availability in all resource-limited areas. Future efforts should thus focus on establishing solutions to address the aforementioned issues and concerns within our healthcare and education systems, thereby ultimately enhancing the standard of medical care.

Investigation on medical practice of overseas acupuncturists based on the top 5 general hospitals in the United States of America and the inspiration / 国际中医中药杂志

This study selected the top five general hospitals in the United States of America, collected the practice information of acupuncturists through the official website, and analyzed the professional department, expertise, professional title, education background, residency, fellowship, board certification, etc. of these acupuncturists to understand the practice situation of acupuncturists in the hospitals. The results of the study showed the practice of acupuncturists in the United States of America is improving. With further localization, locally trained acupuncturists have gradually become the main body of acupuncturists; acupuncture treatment is still mainly for analgesia, but the scope of treatment continues to expand, and departments that accept acupuncturists are gradually increasing. However, the group of licensed acupuncturists is still a minority in the group of acupuncturists in the United States of America. Native American physicians still use acupuncture as an alternative option and neglect to obtain a license. The entry barrier for acupuncturists still needs to be raised.

A qualitative study on the current situation of hospital-institution-community comprehensive prevention of stroke / 中国实用护理杂志

Objective:To deeply explore the real work of primary, secondary and tertiary prevention of stroke in general hospitals, rehabilitation and pension institutions and community health service centers (stations), and to provide reference for improving the level of comprehensive prevention of stroke in the medical system.Methods:From July to November 2022, face-to-face semi-structured interviews with 18 medical staff in general hospitals, 10 medical staff in rehabilitation and pension institutions, and 8 medical staff in community health service centers (stations) were conducted by phenomenological research methods. Colaizzi 7-step analysis method was used to analyze the interview data, and Nvivo12 software was used to code the interview data.Results:Four themes were extracted: hospitals, institutions and communities all played an important role in the comprehensive prevention of stroke and actively cooperated with each other; the public was still lack of comprehensive prevention awareness and correct cognition of stroke; lack of professional medical resources hindered the development of comprehensive stroke prevention; incomplete collaborative mechanism of comprehensive prevention of stroke in hospitals, institutions and communities.Conclusions:In the current comprehensive prevention of stroke, there are still problems such as weak public awareness of prevention, insufficient professional medical resources, and imperfect coordination mechanism. In view of the advantages of medical institutions at all levels, it is necessary to clarify the responsibilities of the system at all levels and explore efficient and sustainable coordination mechanism, so as to improve the comprehensive prevention level of stroke in the medical system.

Application of union physio-psycho-social assessment questionnaire in screening anxiety and depression in outpatients from general hospital / 中华行为医学与脑科学杂志

Objective:To explore the application of union physio-psycho-social assessment questionnaire (UPPSAQ-70) in screening anxiety and depression in outpatients from general hospital.Methods:A total of 510 outpatients from Peking Union Medical College Hospital from June 2020 to November 2021 were recruited.They were assessed with UPPSAQ-70, self-rating anxiety scale (SAS) and self-rating depression scale (SDS). The internal consistency of the UPPSAQ-70 was tested by Cronbach′s α coefficient.The convergent validity of the UPPSAQ-70 was evaluated by examining correlations with the SAS and SDS.Clinical diagnosis, being considering as the " gold standard" , was used to test criterion validity.Result:The UPPSAQ-70 showed good item characteristics and reliability (Cronbach α=0.947). The UPPSAQ-70 total score showed significant correlations with SAS( r=0.843, P<0.01) and SDS ( r=0.852, P<0.01). The area under the curve (AUC) of the UPPSAQ-70 was 0.875 ( P<0.01), the cut-off value was 65 points with the sensitivity 83.2% and the specificity 75.5%.The AUC of the SAS and SDS was 0.848 and 0.808 respectively(both P<0.001). For the SAS(standard score of 50 as the cut-off value), the sensitivity was 47.3%, and specificity was 92.5%.For the SDS(standard score of 53 as the cut-off value), the sensitivity was 62.9%, and specificity was 86.8%. Conclusion:UPPSAQ-70 has high sensitivity and is more suitable for screening of anxiety and depression in general hospital outpatients.

Analysis on patent development at 13 general hospitals in Beijing / 中华医院管理杂志

Objective:To analyze the patent development status of 13 general hospitals in Beijing, for reference in promoting the management and translation of intellectual property rights of public hospitals.Methods:13 tertiary general hospitals in Beijing as one of the top 100 hospitals in China in terms of science and technology evaluaton metrics in 2020 were selected as the research subjects. The patent application and authorization information of 13 hospitals was retrieved from the IncoPat technology innovation intelligence platform, during the period from January 1, 2012 to December 31, 2021. The patent application and authorization status, international patent classification distribution, inventor information, patent validity, and registration of patent transfer were analyzed.Results:The numbers of patent applications and authorizations from 13 hospitals increased from 123 and 13 in 2012 to 2 053 and 2 368 in 2021, respectively. From 2012 to 2021, 13 hospital applied for 10 050 patents and authorized 6 896 patents, including 906 authorized invention patents, 5 863 utility model patents, and 127 appearance design patents. Valid patents amounted to 5 925, accounting for 85.92%, and valid authorized invention patents amounted to 796, accounting for 13.43%. 110 of these patents were transferred or licensed, accounting for 1.60% of the authorized patents.Conclusions:Aapplied and authorizated patents were rising year by year, but the ratios of invention patents and patient translation remained at a low level. The author suggestted that hospitals should highlight the value orientation of patents, strengthen-industry-academia-research cooperation, establish a professional management team and standardized management system for intellectual property, cultivate high-value patents, conduct pre patent application evaluation and screening, and improve patent conversion and technological innovation capabilities.

Analysis of accreditation results and development strategies of tertiary hospitals in Jiangsu province from 2018 to 2020 / 中华医院管理杂志

As an important measure starting for hospital management, hospital accreditation can effectively guide hospitals to improve their comprehensive service capabilities and management level. The accreditation results of 38 tertiary general hospitals in Jiangsu province from 2018 to 2020 showed that there were weaknesses existing in the development of hospitals, including the radiosity and influence of tertiary hospitals, patient service mode, construction of medical technology capabilities and disciplines, medical quality and safety, nursing quality management and specialized nursing, and information construction. The author suggested that hospitals should return to functional positioning, improve the service quality, strengthen construction of hospital disciplines and technical projects, consolidate the foundation of quality and safety management, improve the level of information technology construction, for references for promoting the high-quality sustainable development of tertiary general hospitals.

Current situationanalysis of geriatrics construction in guangxi general hospital / 现代医院

Objective To investigate the current situation of the construction of geriatrics in second and third level gen-eral hospitals in Guangxi,analyze the existing problems,and propose suggestions.Methods A self-developed"Survey on the Current Situation of Geriatrics Construction"was used to conduct a questionnaire survey on 250 second and third level general hospitals in Guangxi from April to September 2021.Results A total of 98 geriatrics were established in 196 general hospitals,and the overall number met national requirements.Among them,36 are independent institutions,including 24 tertiary hospitals and 12 secondary hospitals,with 2 172 beds and 1 764 medical staff.Conclusion In the future,Guangxi should ensure the high-quality construction of geriatrics,reasonably allocate geriatric human resources,enhance disciplinary medical service capa-bilities,strengthen overall two-way health connections,and vigorously promote the construction and development of geriatrics in Guangxi.

Practice of daytime surgery management at a tertiary general hospital based on the incentive compatibility theory / 中华医院管理杂志

Under the background of performance evaluation in nationwide tertiary public hospitals and the DRGs reform, how to improve the efficiency of daytime surgery management is becoming a hotspot for hospital managers. Since July 2020, a tertiary general hospital applied the theory of incentive compatibility to guide the medical workers to consciously strive to achieve such management goals as improving the quantity and quality of daytime surgeries by constructing an organizational management system, increasing performance rewards for daytime surgical teams, rewarding advanced collectives and individuals, convening work coordination and promotion meetings, formulating penalty terms, and strengthening supervision of surgical quality and safety indicators. The implementation rate of daytime surgery in hospitals, the number of departments conducting daytime surgery, the number of covered diseases, and the satisfaction rate of inpatients had increased from 6.94%, 6 departments, 64 diseases, and 90.5% in 2019 to 24.08%, 21 departments, 125 diseases, and 95.0% in 2022, respectively. The incidence of daytime surgical bleeding, and readmissions within 15 days decreased from 0.6% and 0.5% in 2019 to 0.5% and 0.2% in 2022, respectively. The theory of incentive compatibility was in line with the development goals of daytime surgery in China, providing an optimal strategy for improving the management efficiency of daytime surgery according to local conditions.

Experience in radiation protection management in the tertiary general hospital / 中国辐射卫生

@#With widespread popularization, the radiological diagnosis and treatment technology has played an increasingly important role in clinical practice. The tertiary general hospital is generally featured as multiple types of radioisotope and radiation equipment, wide involvement of departments and persons, and many ways of use and potential harms of the radiological diagnosis and treatment technology. Radiation protection has become a content that cannot be ignored in hospital management. This article analyzes the radiation protection management structure of the tertiary general hospital - Guangdong Provincial People’s Hospital. The hospital radiation protection management is gradually improved by clarifying the main leading department, refining duties and responsibilities, strengthening multi-departmental communication and cooperation, and sorting out key connection links. A closed loop of refined management is formed through digging and correcting problems and continuously improving the management level and work efficiency. Valid qualifications are ensured to be obtained in time by radiation workers, radioactive drugs, equipment, and the venues to guarantee the radiation safety of radiation workers and patients and to further promote the construction of the Safe Hospital.

A clínica psicanalítica das urgências subjetivas no hospital universitário: construção de um caso clínico / Psychoanalysis of subjective urgencies at a university hospital: construing a clinical case / La clínica psicoanalítica de urgencias subjetivas en el hospital universitario: construcción de un caso clínico

O hospital constitui-se como um contexto em que a urgência subjetiva pode vir a se apresentar de forma frequente, instaurando, para cada sujeito, uma vivência de angústia. O objetivo desta pesquisa foi investigar as possibilidades para uma clínica das urgências subjetivas no contexto de um hospital universitário em Salvador, considerando as vivências em uma residência multiprofissional. Trata-se de uma pesquisa qualitativa de caráter exploratório, em que se realizou revisão teórica sobre o tema e se construiu um caso clínico, sob orientação psicanalítica. A escolha do caso baseou-se na escuta clínica ao longo dos atendimentos e da atuação em equipe multiprofissional, considerando os impasses ao longo do tratamento. Foram utilizados registros documentais produzidos pela psicóloga residente ao longo dos atendimentos, que ocorreram durante três meses. Os resultados apontam para as contribuições da escuta psicanalítica no tratamento das urgências e na atuação em equipe multiprofissional no contexto hospitalar. A subjetivação da urgência permitiu, no caso em questão, um tratamento pela palavra do que havia incidido diretamente no corpo como fenômeno. Conclui-se pela relevância em discutir o tema da urgência e suscitar novas pesquisas, reintroduzindo no contexto hospitalar a questão sobre a subjetividade.(AU)

Hospitals are contexts in which subjective urgency can frequently materialize, triggering an experience of anguish for each subject. Hence, this research investigates the possibilities of establishing a subjective urgency clinic at a university hospital in Salvador, considering the experiences in a multidisciplinary residence. A qualitative, exploratory research was conducted by means of a theoretical review on the topic and construction of a clinical case, under psychoanalytical advisement. The case was chosen based on clinical listening during the sessions and performance in a multidisciplinary team, considering the obstacles for long-term treatment. Data were collected from documentary records produced by the resident psychologist during three months. Results point to the contributions of psychoanalytic listening to treating subjective urgencies and to the performance of a multidisciplinary team in the hospital context. In the case in question, subjectivation of urgency allowed a treatment through the word of affecting phenomenon. In conclusion, discussing urgency and conducting further research, are fundamental to reintroduce subjectivity in the hospital context.(AU)

El hospital es un contexto en el que frecuentemente se puede percibir una urgencia subjetiva, estableciendo una experiencia de angustia para cada sujeto. El objetivo de esta investigación fue investigar las posibilidades de una clínica de urgencia subjetiva en el contexto de un hospital universitario en Salvador (Brasil), considerando las experiencias en una Residencia Multiprofesional. Se trata de una investigación cualitativa, de carácter exploratorio, en la que se realizó una revisión teórica sobre el tema y construcción de un caso clínico, con orientación psicoanalítica. La elección del caso se basó en la escucha clínica a lo largo de las sesiones y actuación en un equipo multidisciplinar, considerando los impasses para el tratamiento a largo plazo. Se utilizaron registros documentales elaborados por el psicólogo residente, durante las atenciones, que se realizaron durante tres meses. Los resultados apuntan a las contribuciones de la escucha psicoanalítica en el tratamiento de urgencias y en la actuación de un equipo multidisciplinario en el contexto hospitalario. La subjetivación de la urgencia permitió, en el caso en cuestión, un tratamiento a través de la palabra de lo que había afectado directamente al cuerpo como fenómeno. Se concluye que es relevante discutir el tema de la urgencia y plantear nuevas investigaciones, reintroduciendo el tema de la subjetividad en el contexto hospitalario.(AU)

A (DES) INTEGRALIDADE DAS PRÁTICAS DE ATENÇÃO EM SAÚDE MENTAL NUMA EMERGÊNCIA DE UM HOSPITAL "QUASE GERAL" / THE (DIS) INTEGRALITY OF MENTAL HEALTH CARE PRACTICES IN AN EMERGENCY OF AN "ALMOST GENERAL" HOSPITAL

A política de saúde mental brasileira aponta o hospital geral como parte integrante da rede de serviços substitutivos ao hospital psiquiátrico. É preconizado que os serviços substitutivos levem em consideração o acolhimento, o vínculo e a integralidade na prestação do cuidado. O objetivo deste artigo constitui-se em analisar as práticas assistenciais as pessoas com transtornos mentais em uma emergência de um hospital geral e os seus efeitos para integralidade do cuidado. Materiais e métodos: Pesquisa descritiva de abordagem qualitativa. O cenário foi o serviço de emergência de um hospital geral, localizado na zona oeste do município do Rio de Janeiro. Os dados foram obtidos por meio de entrevista semiestruturada e observação participante. Resultados: O espaço físico da emergência pouco favorecia o desenvolvimento de uma atenção acolhedora, resolutiva e humanizada. As práticas assistenciais eram predominantemente pautadas pelo modo asilar. Noções de acolhimento, vínculo e integralidade faziam parte do discurso mas ainda não se materializam nas práticas assistenciais. Discussão: O estigma atribuído à doença mental constituiu-se empecilho à adoção de práticas acolhedoras. Conclusão: A fim de possibilitar que hospital geral adote práticas integrais e que se constitua como parte da rede de serviços substitutivos em saúde mental é necessário investir em novos arranjos institucionais que coloquem o usuário no centro dos modos de produção de atos de saúde; investir na dimensão cuidadora da qualificação dos profissionais de saúde.

The current Brazilian mental health policy points to the general hospital as an integral part of the network of substitutive services to the psychiatric hospital. It is recommended that substitute services take into account, among other premises, the user embracement, bonding and integrality in the provision of care.The purpose of this article is to analyze the care practices of people with mental disorders in a general hospital emergency and their effects for integral care.Materials and methods: Descriptive research of qualitative approach. The scenario of the study was the emergency service of a general hospital, located in the western part of the municipality of Rio de Janeiro. Data were obtained through a semi-structured interview and participant observation.Results: The physical space of the emergency did not favor the development of a warm, resolutive and humanized attention. The care practices were predominantly based on the asylum mode. Notions the user embracement, bond and integrality were part of the discourse, but they did not materialize in the assistance practices. Discussion: The stigma attributed to mental illness was perceived as hindering the adoption the user embracement practices. Conclusion: In order to make it possible for a general hospital to adopt comprehensive and to be part of the network of substitutive services in mental health, it is necessary to invest in new institution arrangements that place the user at the center of the modes of production of health acts.

Journey from seclusion to inclusion: Development of mental health services in India since independence

Mental health is an integral and essential component of “Health”. It is more than the mere absence of mental disorders or disabilities. It determines the quality of life of the individuals. The progress and prosperity of a nation depend on the overall quality of health of its citizens. However, until early twentieth century the issues of mental health and well-being were inadequately addressed. Often people with psychological ailments were considered to be non-productive people, confined in asylums, received inhumane treatment and were completely secluded from the mainstream society. Since independence initiatives have been taken by individuals and by the central government and the state governments, to develop the mental health services in India. This paper reviewed published articles, book-chapters and books to explore the development of mental health services in India since Independence. It was observed that measures were taken to improve the conditions of the mental hospitals. A trend towards deinstitutionalization was set by the Government of India and that initiated the creation of general hospital psychiatric units and community mental health services. Humanistic approach in treatment, development of psychotropic drugs and psychotherapies facilitated the management and care of the patients with psychiatric diseases, thereby improving their quality of life.

Application progress of nurse allocation based on diagnosis related groups in specialized hospitals and general hospitals / 中国实用护理杂志

This article summarized the overview of diagnosis related groups (DRGs), the necessity of comprehensively popularizing and applying DRGs in specialized hospitals and general hospitals, the different methods and effects of nursing human resource allocation based on DRGs in specialized hospitals and general hospitals at home and abroad, and analyzed the different challenges and opportunities faced by DRGs in the implementation of human resource allocation in two types of hospitals. According to the types and characteristics of hospitals, this paper put forward some corresponding suggestions and prospects for the future, such as intelligent human resource prediction system and the construction of information sharing platform, so as to provide reference for the comprehensive promotion of DRGs in different types of hospitals in China.

A qualitative study on the working status of outpatient nurses in general practice departments in general hospitals in Beijing / 中华全科医师杂志

Objective:To survey the working status of outpatient nurses in general practice departments of general hospitals.Methods:From March to April 2021, personal in-depth interviews were conducted with outpatient nurses from general practice residency training bases in Beijing. The thematic framework analysis method was used to analyze the interview data and refine the themes.Results:Fourteen nurses working in general practice outpatient clinics were interviewed in this study. Four themes were extracted from the interview data: (1) inadequate staffing of full-time outpatient nurses in general practice departments of comprehensive hospitals; (2) unclear job functions for outpatient nurses in general practice departments; (3) no standardized patient health education in the department; (4) no relevant training received systematically.Conclusion:General practice departments in general hospitals should setup full-time general practice nurse positions, clarify the job responsibilities, strengthen the relevant training and enhance core competency for nurses working in general practice department.