Pulmonary dysfunction and risk factors in residents of a rural community / 中国基层医药

Objective:To observe the changes of pulmonary function and its influential factors in residents of a rural community and investigate the prevention and control measures.Methods:A survey was made in residents from a rural community in Qingdao who received public health services from September 2017 to December 2019. The demographic data, behavioral and medical history information were collected. Forced vital capacity and forced expiratory volume in one second were measured. The factors that affect lung function were analyzed using univariate analysis and multivariate analysis.Results:This survey involved 5184 residents consisting of 2199 (42.4%) males and 2985 (57.6%) females. 1322 (25.5%) residents had pulmonary dysfunction. Univariate analysis showed that residents aged ≥ 60 years had a higher risk for developing pulmonary dysfunction than residents aged < 60 years (26.1% vs. 14.3%, χ2 = 19.34, P < 0.001), and male residents had a higher risk for developing pulmonary dysfunction than female residents (32.9% vs. 20.0%, χ2 = 110.74, P < 0.001). With the increase in body mass, the incidence of pulmonary dysfunction gradually decreased. The proportion of residents with pulmonary dysfunction with low body mass was higher than that in residents with normal body mass and high body mass (43.4% vs. 27.8% or 22.8%, χ2 = 8.86, 17.63, P = 0.003, < 0.001). The proportion of residents with pulmonary dysfunction was higher in those with a history of chronic bronchitis, bronchial asthma, or obstructive pulmonary disease than in those without such a history (68.3% vs. 23.2%) χ2 = 263.33, P < 0.001). The proportion of residents with pulmonary dysfunction was significantly higher in smokers, whether or not had quit smoking than in non-smokers (35.1%, 36.3% vs. 22.8%, χ2 = 48.83, 86.46, both P < 0.001). The proportion of residents with the normal pulmonary function was not related to the exposure history of dust and chemical poisons and the family history of respiratory diseases ( χ2 = 0.38, 2.29, P = 0.535, 0.130). Multivariate analysis showed that age ≥ 60 years, male sex, low body mass, smoking, and a history of respiratory system diseases were the independent risk factors for pulmonary dysfunction. Among smokers, the number of cigarettes smoked was higher in smokers with pulmonary dysfunction than those with normal pulmonary function ( t = -2.39, P = 0.009). Conclusion:There are many risk factors for pulmonary dysfunction. Primary medical service institutes should carry out pulmonary function testing and formulate targeted prevention strategies, which help realize early detection and treatment of chronic obstructive pulmonary disease.

Population differences of metabolic associated fatty liver disease and nonalcoholic fatty liver disease based on a community elderly population / 临床肝胆病杂志

Objective To investigate the population differences of the newly named "metabolic associated fatty liver disease" (MAFLD) and the former name "nonalcoholic fatty liver disease" (NAFLD). Methods From November 2020 to January 2021, a cross-sectional survey was conducted among 624 elderly individuals aged above 65 years in a community in Beijing, China, and related data were collected, including demographic data, past history, laboratory markers, liver ultrasound, and liver elasticity. According to the presence or absence of fatty liver based on ultrasonic diagnosis, the individuals were divided into fatty liver group with 389 individuals and non-fatty liver group with 235 individuals. The independent samples t -test was used for comparison of normally distributed continuous data between the two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between the two groups; the chi-square test was used for comparison of categorical data between the two groups. Results Among the 389 patients with fatty liver, 387(99.5%) were diagnosed with MAFLD and 368(94.6%) were diagnosed with NAFLD, and there were 19 patients with a history of heavy alcohol consumption and 2 with positive surface antigen. A total of 366 patients met the diagnostic criteria for both MAFLD and NAFLD, accounting for 94.6% of the MAFLD patients and 99.5% of the NAFLD patients. Compared with the non-fatty liver group, the MAFLD group had significant increases in body mass index (BMI) ( t =-11.228, P < 0.05), waist circumference ( Z =-8.532, P < 0.05), hip circumference ( Z =-6.449, P < 0.05), waist-hip ratio ( Z =-5.708, P < 0.05), alanine aminotransferase ( Z =-5.027, P < 0.05), aspartate aminotransferase ( Z =-2.880, P < 0.05), platelet count ( t =-3.623, P < 0.05), triglyceride ( Z =-8.489, P < 0.05), fasting blood glucose ( Z =-3.516, P < 0.05), HbA1c ( Z =-2.884, P < 0.05), Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) ( Z =-0.394, P < 0.05), high-sensitivity C-reactive protein ( Z =-4.912, P < 0.05), controlled attenuation parameter (CAP) ( t =13.744, P < 0.05), and liver stiffness measurement (LSM) ( Z =-7.69, P < 0.05), as well as a significant reduction in high-density lipoprotein cholesterol (HDL-C) ( t =6.348, P < 0.001). Meanwhile, MAFLD patients had more metabolic associated diseases, such as overweight, obesity, central obesity, dyslipidemia, and hypertension ( χ 2 =9.978, 65.472, 36.571, 9.797, and 5.128, all P < 0.05). In the MAFLD group, 30.7% of the patients had non-obese fatty liver disease (BMI < 25 kg/m 2 ), and 11.1% had lean fatty liver disease (BMI < 23 kg/m 2 ); compared with the obese MAFLD patients, the non-obese MAFLD patients had significantly lower age ( Z =-3.042, P < 0.05), BMI ( Z =-15.705, P < 0.05), waist circumference ( Z =-9.589, P < 0.05), hip circumference ( Z =-10.275, P < 0.05), HOMA-IR ( Z =-2.081, P < 0.05), CAP ( t =-3.468, P < 0.05), LSM ( Z =-3.630, P < 0.05), and NAFLD fibrosis score ( t =-4.433, P < 0.05). According to LSM value, advanced liver fibrosis accounted for 3.6% of the MAFLD population, and 10% of the MAFLD population could not be excluded for advanced liver fibrosis. Conclusion The diagnosis of MAFLD can basically cover the NAFLD population in the elderly people, and it is supposed that MAFLD can almost directly replace the concept of NAFLD in similar populations. However, further studies are needed to investigate its application in other populations.

Changes in pediatric hospital care during the COVID-19 pandemic: a national qualitative study.

BACKGROUND: The COVID-19 pandemic has necessitated rapid changes in healthcare delivery in the United States, including changes in the care of hospitalized children. The objectives of this study were to identify major changes in healthcare delivery for hospitalized children during the COVID-19 pandemic, identify lessons learned from these changes, and compare and contrast the experiences of children's and community hospitals. METHODS: We purposefully sampled participants from both community and children's hospitals serving pediatric patients in the six U.S. states with the highest COVID-19 hospitalization rates at the onset of the pandemic. We recruited 2-3 participants from each hospital (mix of administrators, front-line physicians, nurses, and parents/caregivers) for semi-structured interviews. We analyzed interview data using constant comparative methods to identify major themes. RESULTS: We interviewed 30 participants from 12 hospitals. Participants described how leaders rapidly developed new hospital policies (e.g., directing use of personal protective equipment) and how this was facilitated by reviewing internal and external data frequently and engaging all relevant stakeholders. Hospital leaders optimized communication through regular, transparent, multi-modal, and bi-directional communication. Clinicians increased use of videoconference and telehealth to facilitate physical distancing, but these technologies may have disadvantaged non-English speakers. Due to declining volumes of hospitalized children and surges of adult patients, clinicians newly provided care for hospitalized adults. This was facilitated by developing care teams supported by adult hospitalists, multidisciplinary support via videoconference, and educational resources. Participants described how the pandemic negatively impacted clinicians' mental health, and they stressed the importance of mental health resources and wellness activities/spaces. CONCLUSIONS: We identified several major changes in inpatient pediatric care delivery during the COVID-19 pandemic, including the adoption of new hospital policies, video communication, staffing models, education strategies, and staff mental health supports. We outline important lessons learned, including strategies for successfully developing new policies, effectively communicating with staff, and supporting clinicians' expanding scope of practice. Potentially important focus areas in pandemic recovery include assessing and supporting clinicians' mental health and well-being, re-evaluating trainees' skills/competencies, and adapting educational strategies as needed. These findings can help guide hospital leaders in supporting pandemic recovery and addressing future crises.

Panorama da produção científica sobre Cuidados Intermediários e Hospitais Comunitários: uma revisão integrativa / Overview of scientific production on Intermediate Care and Community Hospitals: an integrative review

RESUMO Mudanças epidemiológicas decorrentes do envelhecimento populacional motivaram transformações nos sistemas de saúde mundiais. Desde 1990, emergem discussões sobre Cuidados Intermediários (CI), visando diminuir hospitalizações, melhorar a coordenação do cuidado e estimular políticas públicas de cuidados próximos ao território. Este trabalho objetivou apresentar e analisar a literatura científica sobre CI, enfatizando serviços de Hospitais Comunitários. Realizou-se uma revisão integrativa, combinando os descritores "Intermediate Care", "Community Hospitals", "Intermediate Care Facilities", "Long-Term Care", "Hospitals Chronic Disease" e "Rehabilitation Services", nos idiomas português, inglês e espanhol, nas bases Portal Regional da Biblioteca Virtual em Saúde, PubMed e Biblioteca Digital Brasileira de Teses e Dissertações. Após processo de busca e elegibilidade, foram incluídos 30 documentos para síntese qualitativa, provenientes de: Reino Unido, Noruega, Espanha, Dinamarca, Austrália e Itália. Resultados apontam para a eficácia, a efetividade e a eficiência dos CI, com boas avaliações por parte de profissionais e usuários. Os CI, como estratégia de fortalecimento da Atenção Primária à Saúde, redução de internações, favorecimento da independência funcional dos pacientes e seu retorno à comunidade, apresentam-se como uma inovação em saúde e aposta promissora. Entretanto, persistem lacunas na literatura que ensejam mais estudos sobre o tema, com vistas a subsidiar a tomada de decisão.

ABSTRACT Epidemiological changes resulting from populational aging have led to changes in global health systems. Since 1990, discussions on Intermediate Care (IC) have emerged, with a view to reducing hospitalizations, improving care coordination, and stimulating public care policies close to the territory. This work aims to present and analyze the scientific literature on CI, emphasizing services from Community Hospitals. An integrative review was carried out, combining the descriptors "Intermediate Care", "Community Hospitals", "Intermediate Care Facilities", "Long-Term Care", "Hospitals Chronic Disease", and "Rehabilitation Services", in Portuguese, English and Spanish, in the Regional Portal of Virtual Health Library, PubMed and Digital Library of Thesis and Dissertations bases. After the search and eligibility process, 30 documents were included for qualitative synthesis, coming from: The United Kingdom, Norway, Spain, Denmark, Australia and Italy. Results point to the efficacy, effectiveness and efficiency of ICs, with good evaluations by professionals and users. ICs, as a strategy to strengthen Primary Health Care, reduce hospital admissions, favor patients' functional independence and return to the community, are presented as a health innovation and promising bet. However, there are gaps in the literature that lead to more studies on the topic, with a view to supporting decision making.

Administering Virtual Reality Therapy to Manage Behavioral and Psychological Symptoms in Patients With Dementia Admitted to an Acute Care Hospital: Results of a Pilot Study.

BACKGROUND: As virtual reality (VR) technologies become increasingly accessible and affordable, clinicians are eager to try VR therapy as a novel means to manage behavioral and psychological symptoms of dementia, which are exacerbated during acute care hospitalization, with the goal of reducing the use of antipsychotics, sedatives, and physical restraints associated with negative adverse effects, increased length of stay, and caregiver burden. To date, no evaluations of immersive VR therapy have been reported for patients with dementia in acute care hospitals. OBJECTIVE: This study aimed to determine the feasibility (acceptance, comfort, and safety) of using immersive VR therapy for people living with dementia (mild, moderate, and advanced) during acute care hospitalization and explore its potential to manage behavioral and psychological symptoms of dementia. METHODS: A prospective, longitudinal pilot study was conducted at a community teaching hospital in Toronto. The study was nonrandomized and unblinded. A total of 10 patients aged >65 years (mean 86.5, SD 5.7) diagnosed with dementia participated in one or more research coordinator-facilitated sessions of viewing immersive 360° VR footage of nature scenes displayed on a Samsung Gear VR head-mounted display. This mixed-methods study included review of patient charts, standardized observations during the intervention, and pre- and postintervention semistructured interviews about the VR experience. RESULTS: All recruited participants (N=10) completed the study. Of the 10 participants, 7 (70%) displayed enjoyment or relaxation during the VR session, which averaged 6 minutes per view, and 1 (10%) experienced dizziness. No interference between the VR equipment and hearing aids or medical devices was reported. CONCLUSIONS: It is feasible to expose older people with dementia of various degrees admitted to an acute care hospital to immersive VR therapy. VR therapy was found to be acceptable to and comfortable by most participants. This pilot study provides the basis for conducting the first randomized controlled trial to evaluate the impact of VR therapy on managing behavioral and psychological symptoms of dementia in acute care hospitals.

Relationship between anxiety and psychological resilience of caregivers for community-dwelling dementia patients / 中华老年医学杂志

Objective:To explore the relationship between anxiety and mental resilience of caregivers for community-dwelling dementia patients.Methods:Patients in four communities who met the diagnostic criteria for Alzheimer's disease(AD)were randomly selected and their caregivers served as study subjects.General characteristics, anxiety and resilience of caregivers(n=592)were investigated with a questionnaire developed by ourselves, the Generalized Anxiety Disorder-7 Scale(GAD-7), and the Conner-Davidson Resilience Scale(CDRISC).Results:There were 592 subjects in the study, with 185 cases(31.3%)having anxiety.Differences in manifestations of anxiety existed between caregivers for AD patients in different age groups( P<0.01). Anxiety levels were also influenced by AD patient caregivers' gender, educational level and blood relationship to the patient( P<0.05). The differences were reflected in tenacity( F=72.58), strength( F=82.19), optimism( F=12.57)and the total elasticity score( F=162.88). The Spearman correlation was used to analyze the association of caregiver anxiety with caregivers' general characteristics and domains of psychological resilience.The results showed that anxiety was negatively correlated with gender( r=-0.09, P<0.05), education level( r=-0.112, P<0.01), blood relationship( r=-0.122, P<0.01), psychoelasticity and three other domains( r=-0.457, -0.495, -0.208, -0.60, all P<0.01), but was positively correlated with age( r=0.127, P<0.01). Logistic regression analysis showed that psychoelasticity was a protective factor for anxiety in caregivers for community-dwelling AD patients( β=-0.323, P<0.05). Conclusions:While treating Alzheimer's patients, clinicians can consider psychotherapy measures to improve the psychological resilience of their caregivers.

Transition of a Large Tertiary Heart Failure Program in Response to the COVID-19 Pandemic: Changes That Will Endure.

The coronavirus disease 2019 (COVID-19) pandemic imposed severe restrictions on traditional methods of patient care. During the pandemic, the heart failure program at New York-Presbyterian Hospital in New York, NY rapidly and comprehensively transitioned its care delivery model and administrative organization to conform to a new healthcare environment while still providing high-quality care to a large cohort of patients with heart failure, heart transplantation, and left ventricular assist device. In addition to the widespread adoption of telehealth, our program restructured outpatient care, initiating a shared clinic model and introducing a comprehensive remote monitoring program to manage patients with heart failure and heart transplant. All conferences, including administrative meetings, support groups, and educational seminars were converted to teleconferencing platforms. Following the peak of COVID-19, many of the new changes have been maintained, and the program structure will be permanently altered as a lasting effect of this pandemic. In this article, we review the details of our program's transition in the face of COVID-19 and highlight the programmatic changes that will endure.

[Analysis of antimicrobial resistance and risk factors of community-onset methicillin-resistant staphylococcus aureus infection].

Objective: To analyze risk factors and drug resistance of community-onset methicillin-resistant staphylococcus aureus (CO-MRSA) infection through the investigation of patients infected with CO-MRSA. Methods: The clinical data of 97 cases infected with community-onset staphylococcus aureus (COSA) was collected in this hospital from July 2016 to June 2017. Epidemiological survey method and the variables were determined according to expert consultation, literature and practical work experience. Results: Among 97 patients infected with COSA, the diagnosis rate of CO-MRSA was 21.65%(21/97). The drug sensitivity results showed that: CO-MRSA was high resistant to erythromycin, tetracycline and clindamycin, and the drug resistance rate exceeded 50%. Multiple variables were analyzed by Logistic regression. The usage of antimicrobial agents in the past three months and the history of hospitalization within one year were the independent risk factors. The MRSA infection rate was 57.89%(11/19) of the persons who had taken antibacterial agents in the recent three months.The MRSA infection rate was 48.28%(14/29) of the persons who had been hospitalized in the past one year. OR value of two risk factors was respectively 10.006(95%CI: 2.200-45.519, P=0.030) and 11.519(95%CI: 2.405-55.177, P=0.002). Conclusions: Most COSA is sensitive to methicillin, but CO-MRSA is multidrug resistant and has more risk factors. The clinicians should reasonably use the antibacterial agents according to the drug sensitivity in order to prevent the occurrence of multidrug resistant MRSA.

Application of hospital-community-family home care mobile App in patients with stress urinary incontinence / 中华护理杂志

Objective To evaluate the effects of hospital-community-family home care mobile APP on outcomes of discharged patients with stress urinary incontinence.Methods The hospital-community-family nursing platform for stress urinary incontinence was established.Patients were randomly divided into two groups.Patients in the control group(n=51) were given conventional discharge guidance.Patients in the intervention group(n=54) were given mobile home care intervention based on conventional discharge care.Pelvic floor muscle strength,one hour pad test leakage,the ICI-Q-SF score and self-efficacy were followed up and compared between two groups.Results After 6 months of intervention,symptoms of incontinence in the intervention group were relieved,self-efficacy was higher than the control group,the ICI-Q-SF score was lower than the control group,and the differences were significant(all P＜0.05).Conclusion The hospital-community-family nursing platform for stress urinary incontinence can improve patients' adherence and pelvic floor muscle strength,decrease level of incontinence,and increase quality of life.

A collaborative evaluation of pharmacy interventions in the care of inpatients in community hospitals.

OBJECTIVES: To quantify medication-related errors, in particular prescribing errors, identified by pharmacists and assess their potential impact on inpatients in community hospitals. METHODS: Pharmacists recorded all interventions to optimise medication for community hospital inpatients over 14 days in November 2013. Interventions were subsequently classified by type (prescribing error; omitted or delayed drug administration; or attributable to other issues) and rated for potential clinical impact. RESULTS: 15 organisations participated in the study reporting on 4077 medication charts. In total, 52 033 medication orders were screened by pharmacists. A medication-related intervention was made on 1 in 3 charts for one or more medications. A total of 2782 interventions were recorded. The majority were categorised as a prescriber error (67%, 1872/2782). The remainder (33%, 910/2782) were not directly attributable to prescriber error; of these omitted and delayed medicine administration accounted for 11% (298/2782). Of the 1872 interventions classed as prescriber error, a third, if left undetected, might have caused moderate or severe patient harm. The prescribing error rate was 3.6 errors per 100 medication orders. CONCLUSIONS: Pharmacists reported intervening to improve the care provided to over a third of patients in this study. Two-thirds of interventions were in response to prescribing errors, a third of which, if left undetected, could have led to harm. The results suggest that inpatients in community hospitals are subject to prescribing errors at a rate comparable to those seen in acute and mental health hospitals. A clinical pharmacy service is vital to ensure patient safety in community hospitals.

Feasibility of anticoagulation therapy after mechanical valve replacement in grass-root health institutions / 中华全科医师杂志

Objective To assess the feasibility of anticoagulation therapy after mechanical valve replacement in grass-root health institutions.Methods One hundred and sixty one patients with mechanical valve replacement received anticoagulation therapy with warfarin,including 79 cases receiving the therapy in grass-root health institutions (test group) and 82 cases in the tertiary hospitals (control group).The patients were followed up for 12 months after operation;the rate of anticoagulation efficacy,the anticoagulationrelated complications,and the anticoagulation-related cost were documented and compared between two groups.Results The international normalized ratio (INR) tests were performed for 1 021 times in test group and 717 times were up to anticoagulation standard (70.2 ％,717/1 021),while INR tests in control group were performed for 965 times and 688 times were up to standard (71.3％,688/965);there were no significantly differences in efficacy rate between two groups (P ＞ 0.05).There were no significant differences in rate of bleeding events and thrombosis between two groups [16.5％ (13/79) vs.12.2％ (10/82),6.3％(5/79) vs.4.9％(4/82),respectively,x2 =0.596,P=0.44,x2 =0.161,P=0.69].The anticoagulation-related cost per month and per patient in test group was significantly lower than those in control group [(63.1 ±.12.8) vs.(176.6 ± 16.4) yuan,t =48.716,P ＜0.05].Conclusion Compared with the tertiary hospital,the anticoagulation therapy in grass-root institutions can accomplish the similar clinical outcomes and significantly reduce the medical cost in patients with mechanical valve replacement.

An early stage evaluation of the Supporting Program for Obstetric Care Underserved Areas in Korea.

"The Supporting Program for Obstetric Care Underserved Areas (SPOU)" provides financial aids to rural community (or district) hospitals to reopen prenatal care and delivery services for regions without obstetrics and gynecology clinics or hospitals. The purpose of this study was to evaluate the early stage effect of the SPOU program. The proportion of the number of birth through SPOU was calculated by each region. Also survey was conducted to investigate the extent of overall satisfaction, elements of dissatisfaction, and suggestions for improvement of the program; 209 subjects participated from 7 to 12 December, 2012. Overall, 20% of pregnant women in Youngdong (71 cases) and Gangjin (106 cases) used their community (or district) hospitals through the SPOU whereas Yecheon (23 cases) was 8%; their satisfaction rates were high. Short distance and easy accessibility was the main reason among women choosing community (or district) hospital whereas the reasons of not selecting the community (or district) hospital were favor of the outside hospital's facility, system, and trust in the medical staffs. The SPOU seems to be currently effective at an early stage. However, to successfully implement this program, the government should make continuous efforts to recruit highly qualified medical staffs and improve medical facility and equipment.

Analysis of the applications of antibacterial agents to outpatients in primary hospitals in Hefei City of Anhui Province / 中国基层医药

Objective To investigate the applications of antibacterial agents to outpatients in primary hos -pitals in Hefei City of Anhui Province,and to provide reference for rational use of antibacterial agents.Methods In 2011, fourty-five primary hospitals in Hefei City were selected randomly ,including urban community health service centers (Group A) and township hospitals(Group B),and thirty or fourty outpatient prescriptions were analyzed monthly . Results In Group A, the percentage and intensity of antimicrobial usage , the proportion of the combination and injectable formulation were ( 45.36 ±20.02 )%, ( 89.73 ±25.50 ) DDDs · ( 100 cases ) -1 · d-1 , 13.34%, 23.16%,respectively,and the data in Group B were (61.36 ±17.18)%,(108.46 ±32.27)DDDs· (100 cases) -1 · d-1,29.13%,46.39%,respectively,which the former were significantly lower than the latter.Conclusion In primary hospitals,the applications of antibacterial agents to outpatiants are not rataional ,including high percentages of usage and unreasonable selection of species ,and more supervision and training need to be given to the medical staff , especially in township hospitals .

An Early Stage Evaluation of the Supporting Program for Obstetric Care Underserved Areas in Korea

"The Supporting Program for Obstetric Care Underserved Areas (SPOU)" provides financial aids to rural community (or district) hospitals to reopen prenatal care and delivery services for regions without obstetrics and gynecology clinics or hospitals. The purpose of this study was to evaluate the early stage effect of the SPOU program. The proportion of the number of birth through SPOU was calculated by each region. Also survey was conducted to investigate the extent of overall satisfaction, elements of dissatisfaction, and suggestions for improvement of the program; 209 subjects participated from 7 to 12 December, 2012. Overall, 20% of pregnant women in Youngdong (71 cases) and Gangjin (106 cases) used their community (or district) hospitals through the SPOU whereas Yecheon (23 cases) was 8%; their satisfaction rates were high. Short distance and easy accessibility was the main reason among women choosing community (or district) hospital whereas the reasons of not selecting the community (or district) hospital were favor of the outside hospital's facility, system, and trust in the medical staffs. The SPOU seems to be currently effective at an early stage. However, to successfully implement this program, the government should make continuous efforts to recruit highly qualified medical staffs and improve medical facility and equipment.

Comparison of the diagnostic and therapeutic strategies for patients with benign prostatic hyperplasia between doctors in general hospitals and community hospitals in urban China / 中华老年医学杂志

Objective To comparing the diagnostic and therapeutic strategies for patients with benign prostatic hyperplasia(BPH) between doctors in general hospitals and community hospitals,and to provide scientific clues for the standardization in medical practice.Methods General and community hospitals in urban China were selected via the stratified sampling.127,325 outpatients in these hospitals from December 2011 to December 2012 were randomly recruited.Results The average age of patients was(67.82±8.62) years.There were significant differences in I-PSS,prostate volume,urinary flow rate(UFR) and result of digital rectal examination(DRE) between patients in general and community hospitals.The rates of diagnostic applications were different between doctors in the two kinds of hospitals except I-PSS.Compared with community hospitals,DRE was more frequently applied while ultrasonic inspection and UFR test were less used in general hospitals in North China.A totally opposite situation was observed in East China as compared with the north.The application rates of DRE and UFR test were lower and ultrasonic inspection rate was higher in community hospitals than in general hospitals in South China.Pharmacotherapy was the most common treatment for BPH patients in both types of hospitals(97.53 ％).The rates of drug combinations were statistically different but both were close to 75％ in the two types of hospitals.In community hospitals,the percentage of patients receiving watchful waiting with severe symptoms and signs were lower than that of patients receiving watchful waiting with moderate symptoms and signs,but the percentage of patients receiving operation was not significantly increased.On the contrary,the percentage of patients receiving operation with severe symptoms and signs was higher than that of patients receiving operation with moderate symptoms and signs in general hospitals,but the percentage of patients receiving watchful waiting was not decreased.Conclusions Applications of diagnostic methods are significantly different between doctors in general hospitals and community hospitals and vary among regions.Therapeutic strategies are correlated with the severity of obstructive symptoms or signs.The medication strategy is similar between the two types of doctors.

Weekend physiotherapy practice in community hospitals in Canada.

PURPOSE: To analyze weekend physiotherapy services in acute-care community hospitals across Canada. METHOD: Questionnaires were mailed to acute-care community hospitals (institutions with >100 inpatient beds, excluding psychiatric, mental health, paediatric, rehabilitation, tertiary, and long-term care facilities) across Canada from January to April 2010. The questionnaire collected information on patient referral criteria, staffing, workload, and compensation for weekend physiotherapy services and on the availability of other rehabilitation health professionals. RESULTS: Of 146 community hospitals deemed eligible, 104 (71%) responded. Weekend physiotherapy was offered at 69% of hospitals across Canada, but this rate varied: ≥75% in all regions except Quebec (30%). Hospitals with a high proportion of acute-care beds were more likely to offer weekend physiotherapy services (logistic regression, p=0.021). Services differed among Saturdays, Sundays, and holidays in terms of the numbers of both physiotherapists and physiotherapy assistants working (Kruskal-Wallis, p<0.02 for each). Physiotherapists were predominantly compensated via time off in lieu. Of hospitals not offering weekend physiotherapy, 53% reported that it would benefit patients; most perceived staffing and financial barriers. Social-work services were offered on the weekend at 24% of hospitals and occupational therapy at 16%. CONCLUSIONS: Substantial regional variation exists in access to weekend physiotherapy services in acute-care community hospitals. To address the importance of this variation, research on the efficacy and cost-effectiveness of such services is required.Purpose: To analyze weekend physiotherapy services in acute-care community hospitals across Canada. Method: Questionnaires were mailed to acute-care community hospitals (institutions with >100 inpatient beds, excluding psychiatric, mental health, paediatric, rehabilitation, tertiary, and long-term care facilities) across Canada from January to April 2010. The questionnaire collected information on patient referral criteria, staffing, workload, and compensation for weekend physiotherapy services and on the availability of other rehabilitation health professionals. Results: Of 146 community hospitals deemed eligible, 104 (71%) responded. Weekend physiotherapy was offered at 69% of hospitals across Canada, but this rate varied: ≥75% in all regions except Quebec (30%). Hospitals with a high proportion of acute-care beds were more likely to offer weekend physiotherapy services (logistic regression, p=0.021). Services differed among Saturdays, Sundays, and holidays in terms of the numbers of both physiotherapists and physiotherapy assistants working (Kruskal­Wallis, p<0.02 for each). Physiotherapists were predominantly compensated via time off in lieu. Of hospitals not offering weekend physiotherapy, 53% reported that it would benefit patients; most perceived staffing and financial barriers. Social-work services were offered on the weekend at 24% of hospitals and occupational therapy at 16%. Conclusions: Substantial regional variation exists in access to weekend physiotherapy services in acute-care community hospitals. To address the importance of this variation, research on the efficacy and cost-effectiveness of such services is required.

RÉSUMÉ Objectif : Analyser les services de physiothérapie offerts durant les fins de semaine dans les hôpitaux communautaires de soins de courte durée d'un bout à l'autre du Canada. Méthode : De janvier à avril 2010, des questionnaires ont été postés aux hôpitaux communautaires de soins de courte durée (établissements comptant plus de 100 lits pour hospitalisation, excluant les lits en psychiatrie, en santé mentale, en pédiatrie, en réadaptation, les soins tertiaires et les établissements de soins prolongés) partout au Canada. Le questionnaire visait à recueillir de l'information sur les critères justifiant le renvoi en consultation, le personnel, la charge de travail et la rémunération pour des services de physiothérapie offerts les fins de semaine, et sur la disponibilité d'autres professionnels de la santé œuvrant en réadaptation. Résultats : Des 146 hôpitaux communautaires admissibles, 104 (71 %) ont répondu. Des services de physiothérapie étaient offerts les fins de semaine dans 69 % des hôpitaux au Canada, mais cette proportion varie : ≥75 % dans toutes les régions, sauf au Québec (30 %). Il était plus probable que des services de physiothérapie soient offerts les fins de semaine dans les hôpitaux qui disposent d'une forte proportion de lits en soins de courte durée (régression logistique, p=0,021). Le nombre de physiothérapeutes et d'assistants-physiothérapeutes en poste les samedis, les dimanches et les jours fériés varie, ce qui explique que les services sont différents les samedis, les dimanches et les jours fériés (Kruskal-Wallis, p<0,02 pour chaque profession). Les physiothérapeutes étaient principalement rémunérés par des congés compensatoires. Parmi les hôpitaux n'offrant pas de physiothérapie les fins de semaine, 53 % ont fait savoir que de tels services seraient profitables pour les patients, mais que le manque de personnel et les restrictions financières les empêchaient de les offrir. Des services de travailleurs sociaux étaient offerts les fins de semaine dans 24 % des hôpitaux, et des services en ergothérapie dans 16 % des hôpitaux. Conclusions : L'accès à des services de physiothérapie les fins de semaine fait l'objet de disparités régionales importantes dans les hôpitaux communautaires de soins de courte durée. La mesure de l'étendue de ces disparités pourrait être établie par des recherches sur l'efficacité et sur la rentabilité de tels services.

Exploration of residents' choices for first contact care in Beijing communities and influencing factors / 中华全科医师杂志

A random sample survey was conducted in 17 community medical institutes in 4 districts in Beijing.Among an effective sample of 385 residents.47.5％ (n =183)of community residents chose community medical institutes for first contact care while 52.5％ (n =202) opted for class other hospitals.Residents with lower education levels tended to choose community medical institutes (P =0.01).And those with chronic diseases preferred to choose communities (P=0.00).