Opportunities and Challenges of Tobacco Control Policy at District Level in Indonesia: A Qualitative Analysis

Introduction: Comprehensive tobacco control policies are lacking in Indonesia where smoking prevalence in males is among the highest in the world. This study aims to explore the knowledge, attitude, opportunities and challenges to tobacco control among local stakeholders. Methods: This is a qualitative study using in-depth interviews. Four study areas included Bengkulu Province, Bengkulu City, Seluma District, and Kaur District. Eighteen participants interviewed were from policymakers, legislators, and civil societies during November-December 2020. Thematic data analysis was used. Results: While knowledge and support of the existing Smoke Free Policy (SFP) were high, that of other policies such as outdoor tobacco advertising (OTA) ban and tobacco product display ban were low. Among others, one opportunity was there is already SFP regulation in each study area, to which such bans can be added. Among others, three major challenges were: (a) lack of enforcement of the existing SFP, (b) lack of national regulation to ban OTA and product display, and (c) counter actions by the tobacco industry. Conclusion: The opportunities and challenges identified could be lessons learnt for more comprehensive tobacco control especially by local governments in Indonesia and other countries with similar settings.     

老年人股骨粗隆间骨折手术时机对预后影响的临床研究

目的：探讨老年股骨粗隆间骨折手术时机对临床预后结局的影响。方法整群选取2015年1月—2016年1月该院收治的老年股骨粗隆间骨折患者68例为研究对象。根据患者手术时间将其分为A组与B组, A组32例,B组36例,观察两组患者不同年龄术后30 d、1年的死亡情况。结果两组患者术后30d、1年死亡率比较差异无统计学意义,P>0.05；但A组、B组患者中超过80岁的患者术后1年死亡率明显低于80岁以下年龄患者,P<0.05,差异具有统计学意义。结论年龄超过80岁的老年股骨粗隆间骨折患者术后1年死亡率相对较高。     

Objectives,Budgets, Thresholds,and Opportunity Costs—A Health Economics Approach: An ISPOR Special Task Force Report [4]

The fourth section of our Special Task Force report focuses on a health plan or payer’s technology adoption or reimbursement decision, given the array of technologies, on the basis of their different values and costs. We discuss the role of budgets, thresholds, opportunity costs, and affordability in making decisions. First, we discuss the use of budgets and thresholds in private and public health plans, their interdependence, and connection to opportunity cost. Essentially, each payer should adopt a decision rule about what is good value for money given their budget; consistent use of a cost-per-quality-adjusted life-year threshold will ensure the maximum health gain for the budget. In the United States, different public and private insurance programs could use different thresholds, reflecting the differing generosity of their budgets and implying different levels of access to technologies. In addition, different insurance plans could consider different additional elements to the quality-adjusted life-year metric discussed elsewhere in our Special Task Force report. We then define affordability and discuss approaches to deal with it, including consideration of disinvestment and related adjustment costs, the impact of delaying new technologies, and comparative cost effectiveness of technologies. Over time, the availability of new technologies may increase the amount that populations want to spend on health care. We then discuss potential modifiers to thresholds, including uncertainty about the evidence used in the decision-making process. This article concludes by discussing the application of these concepts in the context of the pluralistic US health care system, as well as the “excess burden” of tax-financed public programs versus private programs.     

对冲性额叶脑挫裂伤合并枕骨骨折的临床特点及治疗（附198例报告）

目的探讨对冲性额叶脑挫裂伤合并枕骨骨折的临床特点和治疗方法。方法回顾性分析198例对冲性额叶脑挫裂伤合并枕骨骨折患者的临床资料,其中急诊手术治疗28例,保守治疗170例（因病情变化,在保守治疗过程中改行手术治疗34例）。结果出院后随访6月～12年,按GOS评分评定预后,恢复良好156例,中残13例,重残17例,死亡12例。结论对冲性额叶脑挫裂伤合并枕骨骨折的患者入院后如果病情危重,危及生命,应急诊手术治疗;如意识障碍较轻,可保守治疗,尽可能延期手术,减少迟发性硬膜外血肿的发生。     

神经源性吞咽障碍的康复护理进展

介绍了神经源性吞咽障碍的评价,主要阐述了功能训练、功能补偿方法、摄食训练的康复方法以及康复训练的时机与时间.     

The Opportunity Loss of Boarding Admitted Patients in the Emergency Department

Objectives: Boarding admitted patients in emergency department (ED) treatment beds has been recognized as a major cause of ED crowding and ambulance diversions. When process delays impede the transfer of admitted patients from the ED to inpatient units, the department's capacity to accept new arrivals and to generate revenue from additional patient services is restricted. The objective of this study was to determine the amount of functional ED treatment capacity that was used to board inpatients during 12 months of operations at a community hospital and to estimate the value of that lost treatment capacity.
Methods: Historical data from 62,588 patient visits to the ED of a 450-bed nonprofit community teaching hospital in south central Pennsylvania between July 2004 and June 2005 were used to determine the amount of treatment bed occupancy lost to inpatient holding and the revenue potential of utilizing that blocked production capacity for additional patient visits.
Results: Transferring admitted patients from the ED to an inpatient unit within 120 minutes would have increased the functional treatment capacity of the ED by 10,397 hours during the 12 months of this study. By reducing admission process delays, the hospital could potentially have accommodated another 3,175 patient encounters in its existing treatment spaces. Providing emergency services to new patients in ED beds formerly used to board inpatients could have generated $3,960,264 in additional net revenue for the hospital.
Conclusions: Significantly higher operational revenues could be generated by reducing output delays that restrict optimal utilization of existing ED treatment capacity.     

中文版共情沟通编码系统在新生儿监护室护患沟通中的应用

目的汉化共情沟通编码系统并应用于新生儿监护室护患沟通,了解护患双方共情沟通行为模式。方法收集新生儿监护室护患沟通的录音,运用汉化的共情沟通编码系统识别和归类患儿父母主动提供的共情机会及分析护理人员对此机会的反应模式。结果共收集32名护理人员与78名患儿父母的对话,识别91个共情机会-共情反应的对话组合。多数患儿父母倾向于直接表达"挑战"(38.5%)和"情绪"(29.7%)类型的共情机会,其次是"间接"(20.9%)和"进展"(6.6%),极少为"护士引发"(4.4%)。护理人员多采取"隐性识别"(27.5%)、"识别但未追问"(23.1%)和"拒绝"(16.5%)的共情回应策略,其中"情绪"型共情机会相对于其他类型能够得到更高层级的共情反应。结论中文版共情沟通编码系统可用于探索护患双方的共情沟通行为模式,为共情培训提供参考。