An overview of neurocritical care in China: a nationwide survey

Background Little quantitative evidence was available regarding the development of NICUs in China. The purpose of this survey was to evaluate the current situation of neurointensive care units （NICUs） across China. Methods The directors of NICUs from 100 tertiary care hospitals across China were contacted and asked to complete a closed response questionnaire regarding their NICUs. Basic information, equipment, and technology information available in the units, as well as staffing information were investigated. Results Seventy-six questionnaires were returned （a 68% response rate）. Of 76 NICUs, 43 units constituted the majority. The number of each NICU bed varied from 4 to 45, occupying 2%-30% of the total department beds. Over 70% of NICUs were equipped with many emergency treatment equipments as well as physiological and biochemical monitoring equipments, while 34%-70% of NICUs still lacked some kinds of equipments such as defibrillators. Some specialist equipments were still partially lacking in 62%-95% of NICUs. A vast majority of the NICUs were equipped with neurocritical care directors, full-time attending physicians, and head nurses, but full-time NICU residents and neurocritical care nurses were still lacking in nearly half （53%） and one-third （33%-37%） of NICUs, respectively. In 76 NICUs, full-time neurointensivists and nurses added up to 359 and 852, respectively. In addition, 78%-97% of all the surveyed NICUs were severely short of non-neurological professional staffs. Conclusion In China, neurocritical care has developed rapidly, but there is still a shortage of well-equipped and well- staffed NICUs across the nation currently.     

Analysis of 100 Cases of Nurse-patient Communication from the Perspective of Ethic,Psychology and Law

With the implementation of the Healthy China Strategy, the value of care has become increasingly prominent. It has become an important nursing topic to strengthen the theoretical and practical research of nurse- patient communication, especially to understand the current state, and explore the essential characteristics, the influencing factors and the differences in interdisciplinary perspectives of nurse-patient communication. Through systematic analysis of 100 real clinical nurse-patient communication cases, this paper found that the problem of poor nurse-patient communication still existed widely, which is prominently manifested as the inhibition of communication willingness, the dislocation of communication topics and the lack of communication consensus. The causes of poor nurse-patient communication were nurses’ poor communication skills, negative emotional distress, the lack of humanistic literacy and insufficient energy investment in communication, as well as the patient’s fragile state, the limitation of knowledge and cultural level, and insufficient trust in nurses. The interdisciplinary perspective analysis of ethics, psychology and law is conducive to enriching and developing the theoretical basis and research methods of nurse-patient communication, and can also provide useful suggestions for improving nurse-patient communication in clinical. © 2022, Editorial department of Chinese Medical Ethics. All rights reserved.     

Critical care medicine in China: history and perspective

Critical care medicine began in 1982 in China and is still in a phase of rapid development.Despite the inadequate resources compared with those of developed countries,critical care medicine has been recognized as a specialty by the government and by other specialties.National critical care societies are dedicated to promoting professional education and the academic improvement of critical care medicine in China.Although critical care services and clinical research are still underdeveloped due to scarce resources,great improvement is expected in the near future.     

Understanding the standard of care in the treatment of type 2 diabetes in China: results from a national survey

Background Given the pace with which standards of care have changed, timely assessment of their impact on routine clinical practice and patient outcomes is needed. In coordination with the Chinese Diabetes Society （CDS）, we developed a quantitative survey to explore the implementation of standards of care for type 2 diabetes （T2D） in China. Methods A national online survey of physicians involved in the management of T2D in China was conducted over a 4-week period in 2012. Completed responses were obtained from 1 028 physicians. Participants responded to 52 questions designed to capture information relating to their demographic and clinical practice profiles. The questionnaire was divided into three sections： basic information, diagnosis practices and screening methods on main complications, and treatment and control practices. The questionnaire was developed in conjunction with the CDS. Results Overall, 83% of surveyed physicians were at least ＂aware＂ of the CDS guidelines on standards of care for T2D. Level of awareness was directly related to hospital grade, specialty, geographic location, professional rank and participation in CDS training. The 2-hour oral glucose tolerance test was reported as the most ever-used approach across all three hospital grades and physician specialties, with a usage rate of 97%. Respondents selected their choice of primary treatment for newly diagnosed T2D patients. Just over half （52%） indicated the use of oral anti-diabetic drugs （OAD） monotherapy, in line with CDS recommendations. However, OAD use varied considerably between different regions and city tiers. Despite hemoglobin Alc being defined as the gold standard for glucose control, it was not universally measured, with more physicians indicating routine use of glucose before fasting and glucose non-fasting. Conclusion The standards-of-care analysis has provided important insights into the current management of T2D among physicians in China across different geographical regions, hospital grades, specialti     

DIAGNOSTIC BEHAVIOR OF COMMUNITY-ACQUIRED PNEUMONIA： SURVEY CONDUCTED IN SOME REGIONS OF CHINA

Objective To analyze the spectrum of microbiological agents causing community-acquired pneumonia （CAP） in recent years. We also investigated the procedure of diagnosis us well as the empirical treatment for this disease in OPD （ outpatient department） of pulmonary disease. Methods A total of 7097 patients from 150 hospitals in 24 provinces in China were enrolled in the study from Nov. 2002 to Mar. 2003. Every patient was diagnosed, treated and registered at the same time. Diagnostic behavior for doctors include chest radiograph and/or CT examination of the lung, as well as collecting sputum samples at the time of diagnosis for bacteria culture to identify the pathogen. Appointed staff fulfiUed the questionnaires and information sheets in each center. After that, data were computerized and analyzed. Results There were 7404 valid information sheets and 7097 questionnaires taken into count. The majority CAP patients were from cities （ 77. 3% ）, most of those who had medical insurance. Most CAP patients had productive cough （81.1% ）, and 76. 7% and 18. 2 % CAP patients received chest film and CT examination respectively for diagnosis. Only 24% patients received sputum sample tested and with 36% got positive results. Streptococcus pneumoniae remained the main pathogen of CAP （43. 2% ）. Most doctors used to prescribe β-lactam antibiotics as the first line of empirical therapy of CAP （ 51.1% ） with oral taken as the main method for drug using （66. 3% ）. Conclusion This survey provides a key point of empirical therapy in China. The procedure for diagnosing us well as the empirical treatment of CAP in OPD of pulmonary disease in China still to be improved, especially in accessing the pathogen. Guidelines developed to recognize and evaluate CAP should base on epidemiological information of the pathogen prevalence, then could offer a rational approach to the initial management of the CAP patients.     

MENTAL RETARDATION AND ITS PREVENTION IN CHINA

While standardized psychological assessment tools are being developed in order to ensure better comparability among prevalence studies on mental retardation in different parts of the country, earlier prevalence figures of 0.78—3.83% gave a rough estimate of the magnitude of the mental retardation problem in this country. In our clinic it was found that 60.6% of severe mental retardation were caused by perinatal conditions and 2.3% by phenylketonuria and primary hypothyroidism, and in an analysis of children with school failure high lead concentration in the body was found to be a related factor. Therefore the majority of mental retardation as seen in China is preventable by primary and secondary prevention. Priority is given to family planning and antenatal care, perinatal care and risk-pregnancy monitoring, early infant care and stimulation, infant nutrition and breast-feeding, and immunization. Although neonatal screening progammes have been initiated in our Institution and some other centers, prevention of genetic conditions may not be a priority at the present stage.     

Sexual Dysfunction among Chinese Nurses:Prevalence and Predictors

This study aimed to estimate the prevalence of and identify the factors influencing female sexual dysfunction (FSD) among Chinese nurses. A cross-sectional survey was conducted from March 2013 to May 2014 among 6 hospitals in Suzhou,China. In total, 2,030 married female nurses were included in the analysis. Data on the sociodemographic, lifestyle, and self-reported health status of the participants were collected,and the participants were asked to complete the Chinese version of the 19-item Female Sexual Function Index (FSFI) questionnaire. In total, 1,035 (50.99%) participants were found to have FSD. Logistic regression analysis showed that increasing age and higher body mass index, lower salary, and poor/very poor self-reported health status were risk factors for FSD; however, regular social activity and physical exercise were protective factors for FSD. The findings of this study suggest that further interventional studies are warranted to study the sexual health among Chinese nurses in detail.     

Nursing-related patient safety events in hospitals

To explore the method of identifying nursing-related patient safety events, types, contributing factors and evaluate consequences of these events in hospitals of China, incident report program was established and implemented in 15 patient units in two teaching hospitals of China to get the relevant information. Among 2935 hospitalized patients, 141 nursing-related patient safety events were reported by nurses. Theses events were categorized into 15 types. Various factors contributed to the events and the consequence varied from no harm to patient death. Most of the events were pre- ventable. It is concluded that incident reporting can provide more information about patient safety, and establishment of a program of voluntary incident reporting in hospitals of China is not only urgent but also feasible.     

Environment surveillance of filamentous fungi in two tertiary care hospitals in China

Background  Invasive fungal infections have constituted an increasingly important cause of morbidity and mortality in immunocompromised patients. In this study, a surveillance project was conducted in three different intensive care units of two large tertiary hospitals in China.

Methods  A one-year surveillance project was conducted in two tertiary hospitals which located in northern China and southwest China respectively. Air, surfaces and tap water were sampled twice a month in a central intensive care unit, a bone marrow transplant unit, a neurosurgery intensive care unit and a live transplant department. Environmental conditions such as humidity, temperature and events taking place, for example the present of the visitors, healthcare staff and cleaning crew were also recorded at the time of sampling.

Results  The air fungal load was 91.94 cfu/m³ and 71.02 cfu/m³ in the southwest China hospital and the northern China hospital respectively. The five most prevalent fungi collected from air and surfaces were Penicillium spp., Cladospcrium spp., Alternaria spp., Aspergillus spp. and Saccharomyces spp. in the southwest China hospital, meanwhile Penicillium spp., Fusarium spp., Aspergillus spp., Alternaria spp. and Cladospcrium spp. in the northern China hospital. The least contaminated department was intensive care units, and the heaviest contaminated department was neurosurgery intensive care unit. Seventy-three percent of all surfaces examined in the northern China hospital and eighty-six percent in the southwest China hospital yielded fungi. Fifty-four percent of water samples from the northern China hospital and forty-nine percent from the southwest China hospital yielded fungi.

Conclusions  These findings suggested that the fungus exist in the environment of the hospital including air, surface and water. Air and surface fungal load fluctuated over the year. Air fungal load was lower in winter and higher in summer and autumn, but seldom exceeded acceptable level. The higher values were created during May to August in the northern China hospital and May to June and September to October in the southwest China hospital. A correlation between air fungal load and humidity, as well as personnel was observed.

     

The Factors Affecting the Length of Stay in the Intensive Care Units of Pertamina Central Hospital in Indonesia Related to Healthcare Associated Infections

HAIs （healthcare associated infections） are important issues and can cause increased morbidity, mortality, and extension of hospital care time. In Indonesia, HAIs in hospitals are most prevalent in the intensive care unit. Within the last three years, BOR （bed occupancy ratio） of Pertamina Hospital has reached 61.77% in 2011 and reached 66.78% in 2013. The hospital has been faced with increased number of inpatients and longer length of stay leading to greater likelihood of the risk of HAIs. The purpose of this study is to identify the factors associated with length of stay （more than 3 × 24 h） in the intensive care unit, and the prevalence rates of HAIs from January 2011 to December 2012. The study uses quantitative cross-sectional survey design with secondary data from the medical record samples of 897 patients and primary data from questionnaires medical personnel of 90 people. Data collection was done through document review of medical records and the data from the Hospital Infection Control Team. The results of the study have shown that there are four factors from medical records related to length of stay, namely, age, the use of invasive medical devices, nutritional status and comorbidities. The results of the questionnaire have shown that majority of the hospital staffs have already had knowledge and attitudes as well as behaviors that adhere to universal precautions. HAIs prevalence in Pertamina Central Hospital in 2011 was 1.15 %, and decreased to 0.27 % in 2012; yet, it was still below 1.5 % in accordance with the national standards from Ministry of Health of Indonesia. Finally, there was a relationship between the occurrence of HAIs and length of stay. It was then recommended to adapt Five Moments for Hand Hygiene Guideline from the WHO （World Health Organization） to reduce HAIs in the Hospital.     

Guidelines for a palliative approach for aged care in the community setting: A suite of resources

In Australia, many people ageing in their own homes are becoming increasingly frail and unwell, approaching the end of life. A palliative approach, which adheres to palliative care principles, is often appropriate. These principles provide a framework for proactive and holistic care in which quality of life and of dying is prioritised, as is support for families. A palliative approach can be delivered by the general practitioner working with the community aged care team, in collaboration with family carers. Support from specialist palliative care services is available if necessary.The Guidelines for a Palliative Approach for Aged Care in the Community Setting were published by the Australian Government Department of Health and Ageing to inform practice in this area. There are three resource documents. The main document provides practical evidence based guidelines, good practice points, tools, and links to resources. This document is written for general practitioners, nurses, social workers, therapists, pastoral care workers, and other health professionals and responded to needs identified during national consultation. Evidence based guidelines were underpinned by systematic reviews of the research literature. Good practice points were developed from literature reviews and expert opinion. Two ‘plain English’ booklets were developed in a process involving consumer consultation; one is for older people and their families, the other for care workers.The resources are intended to facilitate home care that acknowledges and plans for the client’s deteriorating functional trajectory and inevitable death. At a time when hospitals and residential aged care facilities are under enormous pressure as the population ages, such a planned approach makes sense for the health system as a whole. The approach also makes sense for older people who wish to die in their own homes. Family needs are recognised and addressed. Unnecessary hospitalisations or residential placements and clinically futile interventions are also minimised.     

上海市中心城区居家临终患者生活状况及护理指导需求调查

选择2011年1月至2013年12月本社区诊断明确的恶性肿瘤患者、诊断明确的慢性病晚期生活失能患者及照护者各150例,采用自制定量问卷进行面对面调查.112例（74.7％）的照护者认为相对医院而言,患者本人更希望在家里接受护理;95例（63.3％）的照护者护理技术认知水平欠缺,照护技术能力较弱;97例（64.7％）照护者表示希望得到临终患者护理技术指导.说明居家临终关怀可以满足患者的身心需求,但需要社区医疗服务和资源的支持,借助居委会平台集中培训,提供居家照护的技能指导或疾病管理的相关信息支持;需要建立临终关怀互助小组,尽早建立护理规范.     

护理团队在手术室护理质量管理中的应用效果

目的：探讨护理团队对提高手术护理管理质量的效果。方法：将2013年1月至2013年12月在本院实施护理团队管理的80例手术患者设为观察组,将2012年1月至2012年12月实施常规性护理管理的80例手术患者设为对照组,分别于护理团队实施前后采用自行设计的护理质量调查问卷及患者满意度问卷了解患者对护理人员服务意识、工作责任心、解决问题能力、专科知识学习能力、专科操作能力、文书管理能力的评分及满意度,并记录两阶段护理错差率。结果：与未实施护理团队相比,实施后患者对护理人员服务意识、工作责任心、解决问题能力、专科知识学习能力、专科操作能力、文书管理能力的评分显著提高,差异有统计学意义（P〈0.05）。与未实施前相比,实施后配错药、文书归档错误、遵错医嘱、术后压疮发生率显著下降,患者满意度显著提高,差异有统计学意义（P〈0.05）。结论：对手术室实施护理团队管理模式能有效提高护理人员护理质量,降低护理风险,提高患者满意度,有利于建立和谐的护患关系。     

Value Driven Outcomes (VDO): a pragmatic,modular, and extensible software framework for understanding and improving health care costs and outcomes

Objective To develop expeditiously a pragmatic, modular, and extensible software framework for understanding and improving healthcare value (costs relative to outcomes).Materials and methods In 2012, a multidisciplinary team was assembled by the leadership of the University of Utah Health Sciences Center and charged with rapidly developing a pragmatic and actionable analytics framework for understanding and enhancing healthcare value. Based on an analysis of relevant prior work, a value analytics framework known as Value Driven Outcomes (VDO) was developed using an agile methodology. Evaluation consisted of measurement against project objectives, including implementation timeliness, system performance, completeness, accuracy, extensibility, adoption, satisfaction, and the ability to support value improvement.Results A modular, extensible framework was developed to allocate clinical care costs to individual patient encounters. For example, labor costs in a hospital unit are allocated to patients based on the hours they spent in the unit; actual medication acquisition costs are allocated to patients based on utilization; and radiology costs are allocated based on the minutes required for study performance. Relevant process and outcome measures are also available. A visualization layer facilitates the identification of value improvement opportunities, such as high-volume, high-cost case types with high variability in costs across providers. Initial implementation was completed within 6 months, and all project objectives were fulfilled. The framework has been improved iteratively and is now a foundational tool for delivering high-value care.Conclusions The framework described can be expeditiously implemented to provide a pragmatic, modular, and extensible approach to understanding and improving healthcare value.     

糖尿病的护理

随着生活水平的提高,糖尿病的发病率越来越高。然而,糖尿病患者心理压力大,缺乏糖尿病的基本知识,导致自我护理能力差。需要对糖尿病患者进行自我护理指导,帮助患者制定治疗和护理计划,做好终生护理工作;维持血糖的稳定,控制并发症,提高糖尿病患者的生活质量。     

安宁缓和医疗志愿者培训平台建设

为了让全社会的普通大众,不论性别、年龄、职业、受教育程度,都能够了解安宁缓和医疗的核心理念,并运用在自己的生活当中,甚至传播并服务给更多人,北京协和医院安宁缓和医疗组于2021年成立了面向全社会的专业安宁缓和医疗志愿者培训平台。本文对安宁缓和医疗志愿者培训平台的培训设计、内容、方式和结果进行回顾性的梳理和总结,发现平台的培训设计有理论依据,培训内容逻辑完整,培训方法适宜志愿者,培训结果优异。安宁缓和医疗志愿者培训平台建设具有极好的可行性,需要进一步深入探索培训平台的有效性并拓展长期发展策略。     

美国医疗保健经济演变历程及对我国启示

美国作为以市场配置资源著称的发达国家,其医疗保健演化和变革的探索历程,为人类积累了经验和教训,为国内着力优化配置医疗资源相关制度体系的深化设计提供了有益的启发和可贵的警示。本文旨在借"他山之石",结合国内医疗保健经济发展的现实,提取出对"健康中国"国家战略下未来相关制度发展的有益借鉴。     

伤口护理中的营养护理实践

现代伤口护理理论认为，营养护理应贯穿伤口护理的始终。实践证明，动态估计患者的营养状况，并区分营养不良的危险性和程度，是制订和实施个体化营养计划的基础；动态监测与评价营养状况是确保营养护理安全有效的重要环节。本文重点介绍有关伤口护理中营养护理的方法、内容、判断标准、监测指标及并发症预防。     

细节护理在儿科静脉穿刺中的应用

目的:探讨细节护理在儿科静脉穿刺中的应用效果。方法:将683例儿科住院患儿,按照治疗先后随机分为对照组和试验组。对照组给予常规护理,实验组实施细节护理,并对两组患儿输液结束后情况(静脉穿刺成功率、护理差错率及患者满意度等)进行比较分析。结果:试验组实施细节护理后,提高了护士静脉穿刺成功率和患者满意度,护理差错率明显降低,与对照组比较,差异有统计学意义(P<0.05)。结论:细节护理在儿科静脉穿刺中应用价值较高,可以提升患者满意度和护理质量,值得在临床中进一步推广与使用。