Antimicrobial stewardship (AMS) is an important means to control bacterial resistance. The unique situation of intensive care unit (ICU) poses a challenge to AMS. This article reviews the literature on AMS in the ICU at home and abroad in recent years, and summarizes the related measures of AMS. Effective AMS measures in the ICU include setting up a multidisciplinary AMS team, using rapid microbial diagnosis technology to shorten the time of diagnosis, using non-culture methods to assess the necessity of antimicrobial therapy for patients with suspected sepsis, and evaluating the effectiveness of antimicrobial therapy as early as possible and optimizing it. These initiatives aim to increase the rational use of antimicrobials in ICU, reduce the risk of multidrug-resistant infections, and improve patients’ condition.
Objective To analyse the content and structure of the health management policy text for chronic obstructive pulmonary disease (COPD) in China, and to provide a reference for the optimization and improvement of subsequent relevant policies. Methods We searched for relevant policy documents on COPD health management at the national level from January 2017 to December 2023, constructed a two-dimensional analysis framework for policy tools and chronic disease health management processes, coded and classified policy texts, and used content analysis method to analyze policy texts. Results Twenty-four policy texts were included. There were 183 codes for policy tool dimension, with supply based, environmental based, and demand based tools accounting for 43.72%, 47.54%, and 8.74%, respectively. There were 124 codes for the dimension of health management processes, with health information collection and management accounting for 12.10%, risk prediction accounting for 14.52%, intervention and treatment accounting for 66.13%, and follow-up and effectiveness evaluation accounting for 7.26%. Conclusions At present, the proportion of policy tools related to the management of COPD in China needs to be dynamically adjusted. Environmental tools should be appropriately reduced, the internal structure of supply tools should be optimized, the driving effect of demand tools should be comprehensively enhanced, the coupling of COPD health management processes should be strengthened, and the relevant policy system and overall quality should be continuously improved.
ObjectiveTo review the perioperative blood management (PBM) of total knee arthroplasty (TKA) and total hip arthroplasty (THA).MethodsRecent researches on PBM for TKA and THA were comprehensively read and summarized. Then the advantages and disadvantages of various measures together with the clinical experience of West China Hospital of Sichuan University were evaluated from three aspects, including optimizing hematopoiesis, reducing blood loss and blood transfusion, which could provide a basis for clinical selection.ResultsThere are many PBM methods in TKA and THA, among which the optimization of hematopoiesis mainly includes the application of perioperative iron and erythropoietin. Measures to reduce bleeding include the use of tourniquet, intraoperative controlled hypotension, and perioperative antifibrinolytic agents. Autologous blood transfusion includes preoperative autologous blood donation, hemodilution and cell salvage. Allogeneic blood transfusion is the ultimate treatment for anemia. The application of erythropoietin combined with iron therapy for blood mobilization before surgery together with intraoperative controlled hypotension for bleeding control and the multiple use of tranexamic acid can achieve satisfactory clinical results.ConclusionIn the perioperative period of TKA and THA, single or multiple use of different blood management measures should be considered carefully according to the physical and economic conditions of patients individually, so as to reduce the blood loss and allogeneic blood transfusion optimally, and finally accelerate the recovery of patients.
Dysphagia is a common non-motor symptom in Parkinson’s disease (PD), with a high incidence and insidious progression. It can lead to complications such as dehydration, malnutrition, aspiration pneumonia, and even death, seriously affecting the quality of life and prognosis of patients. Therefore, early screening, assessment, and intervention are crucial for improving the quality of life and prognosis of PD patients with dysphagia. This article mainly reviews the risk factors and management strategies of dysphagia in PD, with the aim of providing a reference for healthcare professionals to conduct subsequent evaluations and develop targeted interventions.
Objective To assess the current status of medical waste management and classification disposal in hospitals across Hubei Province, providing a scientific basis for optimizing medical waste disposal strategies and promoting waste minimization, harmless treatment, and resource utilization. Methods A random sample survey was conducted on medical and health institutions in Hubei Province between January 8 and January 17, 2025. The self-made survey questionnaire was used to survey and analyze the medical waste management and classification disposal in medical and health institutions. Results A total of 257 medical and health institutions were surveyed. Among them, there were 93 tertiary hospitals (36.19%), 75 secondary hospitals (29.18%), 77 primary hospitals (29.96%), and 12 non-graded medical institutions (4.67%). The overall compliance rate for medical waste management and training exceeded 90%. In terms of medical waste supervision sections, compliance rates in primary hospitals and non-graded hospitals were 77.92% (60/77) and 58.33% (7/12), respectively. The compliance rate for medical waste classification and disposal was above 90%, with a 100% (221/221) compliance rate for the disposal of placentas from normal deliveries. However, the standardized disposal rates for “fetal tissues from pregnancies under 16 weeks or weighing less than 500 grams”, “amputation and other human tissues (or organs)” and “dead fetus” were 81.45% (180/221), 44.65% (96/215), and 79.64% (176/221), respectively. Additionally, 87.16% (224/257) of healthcare institutions classified single-use soft infusion bottles (bags) as recyclable waste, but significant variations were observed in the disposal of uncontaminated waste (e.g., empty disinfectant bottles, empty dialysis fluid barrels, oxygen humidifier bottles, and orthopedic casting materials). Furthermore, 99.61% (256/257) of hospitals provided protective equipment for medical waste handlers, 91.83% (236/257) conducted regular health examination to them, and 97.28% (250/257) had established needle stab reporting systems and related training programs. Conclusions Medical waste management and classification in hospitals across Hubei Province are largely standardized. However, the certain categories of medical waste still require stricter regulation and oversight.
