Objective
To discuss the running effect of the modified hospital-community integrated two-way-referral service mode in day surgery.
Methods
The hospital-community integrated two-way-referral service mode in day surgery was built in May 2014 by our center, and applied in the communities’ health service network in Chenghua District, Wuhou District, and Jinjiang District. From March 2017 some improvements of the mode were made, such as assigning specific person for the management of two-way-referral, conducting lectures in communities to train the community medical staff, and carrying out gratuitous treatment. The community acceptance rate and patients satisfaction were retrospectively analyzed between March of 2016 and March of 2017, and the number of upward referral (from community to hospital) was retrospectively analyzed between March to June of 2016 and March to June of 2017.
Results
The community acceptance rate was elevated from 81.3% to 99.1% and the patients satisfaction was improved from 95.4% to 100.0%, and the differences between the two periods were statistically significant (P<0.05). The number of upward referral increased from 0 to 23.
Conclusions
The modified hospital-community integrated service mode could optimize the course of surgery appointment, and make it convenient for patients. Furthermore, it also adjusts the reasonable allocation of medical resource effectively and promotes the implementation of national hierarchical medical system.
ObjectiveTo investigate the status and problems of facility allocation in 22 health service centers and township health centers in Fucheng District of Mianyang city, in order to provide references for improving health services in these medical units.
MethodsAccording to the national guidance of facility configuration in township hospitals, the questionnaire was made to survey on the allocation of medical facilities, durable years and frequency of use in 22 medical units of Fucheng district (11 urban community health service centers and 11 township health centers) from November to December 2010. The descriptive and stratified analysis was performed for the survey results.
ResultsMost equipment and facilities required in "Guide Criteria for Installation of Equipment and Facilities in Urban Community Health Service Centers" including facilities for diagnosis, treatment and health education were not installed and there were problems of poor property and low frequency of use. The medical equipment was seriously inadequate in 11 township health centers.
ConclusionCommunity basic equipment resource should be improved as soon as possible.
Objective
To improve the model of hospital-community integrated service of day surgery through quality control circle (QCC).
Methods
To optimize the community follow-up management of day surgery patients, we used QCC between March and August 2015 to find out the real reasons for community follow-up problems in day surgery patients and developed and implemented corresponding countermeasures. Comparison of health education, postoperative follow-up of dressing changes, and doctor-patient satisfaction assessment before and after the implementation of the model of hospital-community integrated service of day surgery (September 2014-February 2015vs. September 2015-February 2016) was then performed.
Results
After QCC implementation, the average number of dressing changes in the hospital was reduced from 4.58±0.95 to 1.18±0.39 (t=181.194,P<0.001). The average number of dressing changes in the community increased from 1.42±0.52 to 4.32±0.88 (t=–146.245,P<0.001). The average number of health consultation increased from 0.85±0.38 to 6.39±1.20 (t=–177.096,P<0.001). The satisfaction assessment after QCC implementation among doctors, nurses and patients also significantly increased (P<0.01).
Conclusion
Applying QCC can improve the model of hospital-community integrated service of day surgery and have remarkable effects on postoperative rehabilitation and patients’ satisfaction.
ObjectiveTo investigate the etiologic feature and prognosis of adult patients with severe community-acquired pneumonia (SCAP).
MethodsAccording to the guideline on the diagnosis and treatment of community-acquired pneumonia in 2006, 105 patients with SCAP were included in the study. The proportion of pathogens (including multiple resistant bacteria) and mortality rate were recorded. Appropriate statistical methods were selected and all data were analyzed by using SPSS Version 18.0 computerized program.
ResultsThe predominant pathogen with SCAP was Pseudomonas aeruginosa, followed by Klebsiella pneumoniae, Staphylococcus aureus, and Legionella pneumophila. In death cases, Klebsiella pneumoniae was the most common pathogen, followed by Staphylococcus aureus. It was showed in the drug sensitivity test that most pathogens were drug-sensitive strains. The patients with tumor had higher risks to get infected with Gram-negative bacillus.
ConclusionsThe etiology of patients with SCAP in our emergency department is given priority to Gram-negative bacillus and sensitive strains, of which Pseudomonas aeruginosa and Klebsiella pneumoniae are predominant. As for the Gram-positive cocci, Staphylococcus aureus is the most common pathogen. Legionella pneumophila is the most common pathogen in atypical pathogens, which only account for a small proportion of the aetiology of SCAP. Patients with Klebsiella pneumoniae and Staphylococcus aureus infections are associated with poor prognosis.
Objective To understand the current rate of nosocomial infection and its changing trend in a grade A comprehensive hospital in 10 years, and to provide scientific basis for the monitoring, control and management of nosocomial infection. Methods Using the method of cross-sectional survey, the inpatients in Mianyang Central Hospital from 2011 to 2020 were selected for bedside survey, and the questionnaire was filled in after review of medical records. The data of cross-sectional survey of nosocomial infection were collected, and the infection-related data of nosocomial and community-acquired infection of patients in each department were statistically analyzed. Results A total of 19 595 cases were investigated. The prevalence rate of nosocomial infection was 3.79%, and the the case prevalence rate of nosocomial infection was 4.04%. The prevalence of community-acquired infection was 33.44%, and the case prevalence rate of community-acquired infection was 35.30%. The departments with higher prevalence rate in nosocomial infection were intensive care unit, neurosurgery, cardiothoracic surgery and hematology. The departments with high prevalence rate in the community-acquired infection were burn department, pediatrics department, neonatology department, respiratory medicine department and pediatric intensive care unit. The most common site of nosocomial infection was lower respiratory tract infection, followed by upper respiratory tract sensation, urinary tract, abdominal tissue and blood. The main pathogens of nosocomial infections were Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, Staphylococcus aureus, and Pseudomonas aeruginosa. The utilization rate of antibacterial drugs was 42.93%. There was a downward trend in prophylactic drug use, mainly one drug combination, and the proportion of combination drug decreased.Conclusion Through the investigation, it can be seen that the key points of nosocomial infection management and prevention and control should be lower respiratory tract infection, postoperative surgical infection, multi-drug resistant bacteria management and rational use of antibiotics.
ObjectiveTo evaluate the reasonableness of anticoagulation management strategy in patients after mechanical heart valve replacement.
MethodsAll patients were followed and registered continually at outpatient clinic from July 2011 to February 2013, with a minimum of 6 months after surgery. Targeted international normalized rate (INR) 1.60 to 2.20 and warfarin weekly dosage adjustment were used as the strategy of anticoagulation management. Except bleeding, thrombogenesis and thromboembolism, time in therapeutic range (TTR) and fraction of TTR (FTTR) were adopted to evaluate the quality of anticoagulation management.
ResultsA total 1 442 patients and 6 461 INR values were included for data analysis. The patients had a mean age of 48.2±10.6 years (14-80 years) and the following up time were 6 to 180 months (39.2±37.4 months) after surgery. Of these patients, 1 043 (72.3%) was female and 399 (27.7%) was male. INR values varied from 0.90-8.39 (1.85±0.49) and required weekly doses of warfarin were 2.50-61.25 (20.89±6.93 mg). TTR of target INR and acceptable INR were 51.1% (156 640.5 days/306 415.0 days), 64.9% (198 856.0 days/306 415.0 days), respectively. FTTR of target INR and acceptable INR were 49.4% (3 193 times/6 461 times), 62.6% (4 047 times/6 461 times). There were 8 major bleeding events, 7 mild bleeding events, 2 thromboembolism events, and 2 thrombogenesis in the left atrium.
ConclusionIt is reasonable to use target INR 1.60-2.20 and warfarin weekly dosage adjustment for patients after mechanical heart valve replacement.
ObjectiveTo explore the clinical value of the soluble urokinase type plasminogen activator receptor (suPAR) level in bronchoalveolar lavage fluid (BALF) for evaluateting the disease severity and prognosis of severe community-acquired pneumonia (SCAP).
MethodsEighty-four patients with SCAP were recruited as a SCAP group from the respiratory department, ICU and RICU between April 2014 and April 2016. According to their organ dysfunction, the SCAP patients were subdivided into a MODS group and a non-MODS group. Depending on the treatment response on the 7th day of treatment, they were subdivided into an effective group and an ineffective group. According to the survival condition within 28 days, they were subdivided into a survival group and a death group. Meanwhile, 50 cases with non-severe common community acquired pneumonia were recruited as a control group. On the admission day, all cases were evaluated by PSI score and APACHE Ⅱscore. The serum suPAR level were detected by ELISA on the 1st day in hospital. The suPAR and procalcitonin (PCT) levels in the patient's BALF and serum were detected on the 1st, 3rd, 7th day, discharge or death day. The symptoms and signs, biochemical and pulmonary imaging changes were also observed.
ResultsThere were no differences in the sex, age, body weight, duration of pneumonia, or complicated diseases such as hypertension, coronary heart disease and cerebral vascular diseases between the SCAP group and the control group (all P > 0.05). The suPAR levels in serum and BALF of the SCAP group were higher than those of the control group with significant differences (all P < 0.05). The suPAR level in BALF was obviously higher than that in serum in the SCAP group with significant difference (P < 0.05), and slightly higher than that in serum in the control group with no significant difference (P > 0.05). The level of suPAR in BALF of the MODS group was significantly higher than that in the non-MODS group with significant difference (P < 0.05), but there was no significant difference in the PCT level between the two groups (P > 0.05). The suPAR level in the ineffective treatment group was significantly higher than that in the effective treatment group on the 7th day in hospital with significant difference (P < 0.05). The suPAR levels in BALF of the death group were higher than those in the survival group at each time point after admittion with significant difference (all P < 0.05), and the PCT levels had no significant difference between the two groups within 1 week of each time point (all P > 0.05). The suPAR level in BALF of the SCAP group was positively correlated with APACHEⅡ score and PSI score (r=0.578, P=0.0085; r=0.565, P=0.0071), and plasma PCT level was weakly correlated with the APACHEⅡ score and PSI score (r1=-0.0137, r2=-0.0152).
ConclusionThe SuPAR level in BALF of patients with SCAP is closely related to the severity and prognosis, and can be used as an index to assess the severity and prognosis.
Objective To understand the cognition and acceptance of community hemodialysis centers among hemodialysis patients in Yangzhou, and to provide theoretical basis for the development of community hemodialysis centers. Methods A cluster random sampling method was used to select 400 maintenance hemodialysis patients treated in various areas of Yangzhou in April 2021 for a questionnaire survey to analyze the influencing factors of patients’ medical treatment behavior. Results A total of 390 valid questionnaires were recovered, with an effective recovery rate of 97.50%. Among the patients, 40.51% were very concerned about the construction of hemodialysis centers in the community, 56.67% understood the relevant policies, and 56.92% of the patients were willing to choose the community for dialysis treatment. The results of logistic regression analysis showed that the main factors affecting whether patients choose community for hemodialysis treatment include the patients’ residence [Jiangdu vs. Guangling: odds ratio (OR)=7.183, 95% confidence interval (CI) (2.010, 25.674), P=0.002; Gaoyou vs. Guangling: OR=22.512, 95%CI (7.201, 70.373), P<0.001; Yizheng vs. Guangling: OR=25.137, 95%CI (7.636, 82.744), P<0.001; Baoying vs. Guangling: OR=23.784, 95%CI (7.795, 72.569), P<0.001], degree of concern [some concern vs. very concerned: OR=0.267, 95 %CI (0.137, 0.521), P<0.001; not very concerned vs. very concerned: OR=0.062, 95%CI (0.023, 0.168), P<0.001; not concerned vs. very concerned: OR=0.101, 95% CI (0.023, 0.439), P=0.002], awareness [somewhat know vs. know very well: OR=0.025, 95%CI (0.002, 0.318), P=0.004; don’t know very well vs. know very well: OR=0.035, 95%CI (0.003, 0.439), P=0.009; don’t know vs. know very well: OR=0.006, 95%CI (0.000, 0.084), P<0.001]. Conclusions Hemodialysis patients in Yangzhou have a low level of awareness and acceptance of community-based hemodialysis centers. The patients’ residence, degree of attention and awareness of community-based hemodialysis center directly affect whether they choose the community for treatment. The relevant departments and medical institutions can start from the factors that affect patients’ choice of medical treatment, further strengthen the publicity of community dialysis, optimize the allocation of medical resources, and improve the capacity of community health services.
Objective To explor the influence of the hospital-community-family mental rehabilitation mode on the quality of life of patients with schizophrenia. Methods We selected 101 patients diagnosed as schizophrenia according to ICD-10, who were hospitalized in mental health center of the West China Hospital and took part in rehabilitation voluntarily after discharge. Those patients were randomly assigned to two groups. Hospital-community-family mental rehabilitation mode intervention was applied to the patients based on inpatient rehabilitation in the trial group (n=52), while inpatient rehabilitation alone was applied in the control group (n=49). The total score of quality of life, psycho-social dimension, motivation and energy dimension, score of mental disability and social function, and family social care index were recorded. Then, statistical analysis was performed using SPSS 17.0 software. Results After 3 months and 6 months, the trial group had lower scores of the total score of quality of life, psycho-social domain, and motive and energy dimension than those of the control group (Plt;0.05). After 6 months, the trial group had lower scores of mental disability and social function (Plt;0.05) but a higher score of family social care index (Plt;0.05). The scores of WHO-DSA II and SQLS were positively correlated, while the scores of APGAR and SQLS were negatively correlated. Conclusion The integral mode of hospital-community-family mental rehabilitation effectively improves the quality of life of patients with schizophrenia, which also positively improves patients’ rehabilitation.
ObjectiveTo compare the predictive value of the BAP-65 score, the DECAF score, the CURB-65 score, and the Pneumonia Severity Index (PSI) on short-term mortality and adverse outcomes in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with community-acquired pneumonia (CAP). MethodsThis study enrolled patients hospitalized for AECOPD and CAP from ten hospitals in China from September 2017 to July 2021. All-cause mortality within 30 days was investigated. Patients were divided into the death and the survival groups according to their survival status. The differences in basic conditions, complications, symptoms, signs and auxiliary examination results between the two groups were compared, and the independent risk factors of all-cause mortality were analyzed. The included patients were scored and graded according to the 4 scales, respectively, and the validity of the four scales in predicting short-term mortality and adverse outcomes was compared based on the receiver operating charateristic (ROC) curve analysis. ResultsA total of 3375 patients including 2545 males and 830 females with a mean age of (73.66 ±10.73) years were enrolled in this study. Within 30 days, 129 (3.82%) patients died and 614 (18.19%) patients had an adverse outcome (including all-cause death, invasive mechanical ventilation and admission into intensive care unit). Altered state of consciousness, diabetes mellitus, atrial fibrillation, chronic pulmonary heart disease, age, pulse rate, serum albumin, diastolic blood pressure, and pH value were independent risk factors for 30-day mortality in AECOPD patients with CAP. The area under the ROC curve (AUC) of the CURB-65 score, BAP-65 score, DECAF score, and PSI score for predicting all-cause mortality were 0.780, 0.782, 0.614, and 0.816, and these AUCs for predicting adverse outcomes were 0.694, 0.687, 0.564 and 0.705, respectively. PSI score had the best predictive efficacy for all-cause mortality and adverse outcomes, and the DECAF score had the worst predictive efficacy. ConclusionsAECOPD patients with CAP have a relatively high incidence of all-cause mortality and adverse outcomes within 30 days. Altered state of consciousness, diabetes mellitus, atrial fibrillation, chronic pulmonary heart disease, age, pulse rate, serum albumin, diastolic blood pressure, and pH value are independent risk factors for 30-day mortality. PSI score has the best performance in predicting all-cause mortality and adverse outcomes, while the DECAF score has the worst performance.
