This study aimed to clarify the conditions surrounding fatigue that are common to medical professionals working in emergency and critical care centers in Japan. Semi-structured interviews were conducted with eight pro...This study aimed to clarify the conditions surrounding fatigue that are common to medical professionals working in emergency and critical care centers in Japan. Semi-structured interviews were conducted with eight professionals ranging from doctors, nurses and pharmacists to clinical engineering technologists and radiation technologists. Their narratives were analyzed using the qualitative descriptive approach to determine fatigue common to all professionals and the reasons behind it. The five categories that emerged as the reasons for fatigue common to the subjects were [playing one’s role in treatment and procedures for emergency and critical patients], [accommodating the patient’s background and coming to terms with the outcome], [difficulties in liaising with other professionals], [feeling pressure as a responsible professional in emergency care] and [loss of sense of time caused by variable working hours]. The results revealed that fatigue common to all of the subjects was related to dealing with patients, coordinating with other professionals, having professional responsibilities and the working environment. This study suggests that arrangements to improve the working environment, ensure adequate staffing, and provide mental health support for the well-being of medical professionals working in emergency and critical care centers are necessary.展开更多
Aim: The purpose of this study was to develop a scale, “parental anxiety about pediatric emergency medical care services” (PAPEMCS), and to evaluate its psychometric properties. Methods: Participants were 14,510 par...Aim: The purpose of this study was to develop a scale, “parental anxiety about pediatric emergency medical care services” (PAPEMCS), and to evaluate its psychometric properties. Methods: Participants were 14,510 parents with children 6 years old or younger in Kagawa Prefecture. Using each half of the participants, exploratory factor analysis was performed to generate items and factors for the PAPEMCS, and confirmatory factor analysis (CFA) was used to establish the construct validity. The generalizability of the PAPEMCS was evaluated by congruence tests and multigroup CFA. The usefulness of the PAPEMCS was established by the relationship between the PAPEMCS and non-urgent usage of pediatric emergency medical care services (PEMCS). Results: The PAPEMCS compromised 4 factors: “anxiety about quality of PEMCS”, “anxiety about PEMCS system”, “anxiety about public support”, and “anxiety about private support”. All reliability estimates (polychoric ordinal alpha coefficients, item-rest correlations), the item discrimination, 5 fit indices for CFA, the convergent validity (indicator reliabilities, composite reliabilities, average variance extracteds), and the discriminant validity fulfilled the acceptability thresholds. All generalizability estimates fulfilled the predetermined levels of acceptability (Tucker’s congruence coefficients, congruence tests, strict factorial invariance). The usefulness of the PAPEMCS was established by the higher scores of the PAPEMCS being related to non-urgent usage of PEMCS. Conclusions: The PAPEMCS demonstrated satisfactory reliability, validity, generalizability and usefulness. The PAPEMCS is useful to quantify the contents and extent of parental anxiety about PEMCS, and to clarify the mechanisms of non-urgent PEMCS usage.展开更多
With the gradual intensification of aging in China,the issue of elderly care has become the primary issue that needs to be urgently solved in society.The construction of a reasonable and scientific integrated medical ...With the gradual intensification of aging in China,the issue of elderly care has become the primary issue that needs to be urgently solved in society.The construction of a reasonable and scientific integrated medical and care service system can not only efficiently allocate medical resources and services,but also better meet the needs of the elderly.Due to the involvement of multiple disciplines such as architecture,sociology,psychology,and behavioral science in the construction of the system,as well as the restriction of various objective factors such as medical capacity,spatial scale,and operating costs,the government and elderly care institutions have always been unable to find the best solution for how to scientifically and reasonably construct an integrated medical and care service system.This paper is based on Anshan City,Liaoning Province,which has prominent aging issues and distinct characteristics of the elderly population.Through extensive field research in elderly care institutions,and face-to-face communication with personnel from relevant government departments such as the Municipal Commission on Aging,the Civil Affairs Bureau,the Health Commission,the Medical Insurance Bureau,and the Human Resources and Social Security Bureau,it truly understands the problems that arise in the construction of the urban integrated medical and care service system.From three aspects:urban situation,institutional situation and the needs of the elderly,it is proposed to establish a clear departmental linkage mechanism with clear rights and responsibilities,a policy guarantee mechanism tailored to local conditions,a multi-measure operation mechanism,a technology first intelligent response mechanism,a warm and efficient service mechanism for the people,an overall layout mechanism,an evaluation and supervision mechanism for full process control,and a talent supply mechanism of external introduction and internal training.It aims to provide reference for the construction of an integrated medical and care service system in similar cities.展开更多
Objective:To explore the clinical efficacy of the integrated medical care model combined with psychological intervention in pulmonary tuberculosis patients with lung cancer.Methods:From January to December 2022,60 pul...Objective:To explore the clinical efficacy of the integrated medical care model combined with psychological intervention in pulmonary tuberculosis patients with lung cancer.Methods:From January to December 2022,60 pulmonary tuberculosis patients with lung cancer admitted to our hospital were selected as the research subjects.Using the random number table method,the patients were divided into two groups,a control group and a study group,with 30 cases in each group.The chest computed tomography(CT)examination results,mental state assessment(including depression scale and anxiety scale)scores,incidence of adverse reactions,treatment effect,and length of hospital stay were compared between the two groups.Results:The treatment effect of the patients in the study group was better than that of the patients in the control group(P<0.05);the duration of hospitalization,chest CT examination results,mental state assessment scores,and incidence of adverse reactions of the study group and the control group,were significantly different(P<0.05).Conclusion:The integrated medical care model combined with psychological intervention can effectively improve the treatment effect of pulmonary tuberculosis patients with lung cancer and prevent the occurrence of adverse reactions;thus,it should be promoted in clinical practice.展开更多
Objective:To explore the effect of integrated medical and nursing care in patients with pulmonary tuberculosis combined with lung cancer.Methods:From August 2021 to August 2022,60 patients with pulmonary tuberculosis ...Objective:To explore the effect of integrated medical and nursing care in patients with pulmonary tuberculosis combined with lung cancer.Methods:From August 2021 to August 2022,60 patients with pulmonary tuberculosis combined with lung cancer were admitted.All patients were diagnosed with pulmonary tuberculosis according to the Guidelines for the Diagnosis and Treatment of Pulmonary Tuberculosis and with lung cancer by pathology.The patients were randomly divided into two groups,with 30 cases in each group.The control group received daily nursing care,whereas the study group received integrated medical and nursing care.The sputum conversion rate,tumor remission rate,and quality of life of patients were observed and analyzed.Results:The item function score and symptom function score of the observation group were higher than those of the control group(P<0.05);the total effective rate of the observation group was significantly higher than that of the control group(P<0.05);the sputum conversion rate of the observation group was significantly higher than that of the control group(P<0.05).Conclusion:For patients with pulmonary tuberculosis combined with lung cancer,the application of integrated medical and nursing care can help consolidate the treatment effect and improve the quality of life of patients;thus,it is worthy of promotion and application.展开更多
BACKGROUND： Beijing successfully hosted the 2008 Olympic Games, and the servicesincluding medical services were widely appreciated by both participants and visitors. Weretrospectively analyzed the quality of the medi...BACKGROUND： Beijing successfully hosted the 2008 Olympic Games, and the servicesincluding medical services were widely appreciated by both participants and visitors. Weretrospectively analyzed the quality of the medical services provided to athletes, spectators, VIPs,and the workforce during the Beijing 2008 Olympic Games. The information thus gathered would beuseful for planning strategies for managing mass gatherings.METHODS： Medical encounter forms filled during the Beijing 2008 Olympic Games wereretrospectively reviewed. Descriptive statistics was used to characterize the data by accreditation anddiagnostic categories.RESULTS： A total of 22 892 medical encounters were documented during the Beijing 2008Olympic Games. Among them, 10 549 （46.08%） involved the workforce, 3 365 （14.70%） athletes,3 019 （13.19%） spectators, 585 （2.56%） members of the media, 1 065 （4.65%） VIPs, and 4 309（18.82%） others. Of the 22 892 cases, physical injury accounted for 27.90% （6 386）, respiratorydisease 18.21% （4 169）, and heat-related illnesses 2.68% （615）.CONCLUSIONS： Preparations of the medical service for the Beijing 2008 Olympic Gameswere made for 7 years, and the service provided has been praised worldwide. This study providesvaluable information that may be useful for planning medical services for upcoming Olympic Games,including the London 2012 Olympic Games and other mass gatherings.展开更多
AIM To determine if our health system's integrated model reflects sustained virologic response(SVR) outcomes similar to those in clinical trial data, maximizes adherence, and averts drug interactions.METHODS Subje...AIM To determine if our health system's integrated model reflects sustained virologic response(SVR) outcomes similar to those in clinical trial data, maximizes adherence, and averts drug interactions.METHODS Subjects with chronic hepatitis C had their medical records reviewed from November 1st, 2014 through March 1st, 2016. Patients eligible for treatment were entered into an integrated care model therapy algorithm. The primary outcome was SVR12 based on intention to treat(ITT) analysis. Inclusion criteria consisted of both treatment na?ve and experienced patients over the age of 18 who were at least twelve weeks post-therapy completion with any genotype(GT) or METAVIR score. Secondary outcomes included adherence, adverse events, and number of drug interaction interventions.RESULTS At the time of analysis, 133 patients had reached twelve weeks post therapy with ITT. In the ITT analysis 70 patients were GT 1a, 26 GT 1b, 23 could not be differentiated between GT 1a or 1b, 8 GT 2, 4 GT 3, and 2 patients with multiple genotypes. The ITT treatment regimens consisted of 97 sofosbuvir(SOF)/ledipasvir(LDV), 8 SOF/LDV and ribavirin(RBV), 7 SOFand Simeprevir(SMV), 6 3D and RBV, 1 3D, 11 SOF and RBV, and 1 SOF, peg interferon alpha, and RBV. The overall SVR12 rate was 93% in the ITT analysis with a total of 6 patients relapsing. In patients with cirrhosis, 89% obtained SVR12. All 33 patients who were previous treatment failures achieved SVR12. Drug-drug interactions were identified in 56.4% of our patient population, 69 of which required interventions made by the pharmacist. The most common side effects were fatigue(41.4%), headache(28.6%), nausea(18.1%), and diarrhea(8.3%). No serious adverse effects were reported.CONCLUSION Dean Health System's integrated care model successfully managed patients being treated for hepatitis C virus(HCV). The integrated care model demonstrates high SVR rates amongst patients with different levels of fibrosis, genotypes, and HCV treatment history.展开更多
Point of care ultrasonography(POCUS)has evolved to become the fifth pillar of the conventional physical examination,and use of POCUS protocols have significantly decreased procedure complications and time to diagnose....Point of care ultrasonography(POCUS)has evolved to become the fifth pillar of the conventional physical examination,and use of POCUS protocols have significantly decreased procedure complications and time to diagnose.However,lack of experience in POCUS by preceptors in medical schools and nephrology residency programs are significant barriers to implement a broader use.In rural and low-income areas POCUS may have a transformative effect on health care management.展开更多
Although visiting the emergency departments(EDs) is considered poor quality of cancer care,there are indications these visits are increasing.Similarly,there is growing interest in providing palliative care(PC) to canc...Although visiting the emergency departments(EDs) is considered poor quality of cancer care,there are indications these visits are increasing.Similarly,there is growing interest in providing palliative care(PC) to cancer patients in EDs.However,this integration is not without major challenges.In this article,we review the literature on why cancer patients visit EDs,the rates of hospitalization and mortality for these patients,and the models for integrating PC in EDs.We discuss opportunities such integration will bring to the quality of cancer care,and resource utilization of resources.We also discuss barriers faced by this integration.We found that the most common reasons for ED visits by cancer patients are pain,fever,shortness of breath,and gastrointestinal symptoms.The majority of the patients are admitted to hospitals,about 13% of the admitted patients die during hospitalization,and some patients die in ED.Patients who receive PC at an ED have shorter hospitalization and lower resource utilization.Models based solely on increasing PC provision in EDs by PC specialists have had modest success,while very limited ED-based PC provision has had slightly higher impact.However,details of these programs are lacking,and coordination between ED based PC and hospitalwide PC is not clear.In some studies,the objectives were to improve care in the communities and reduce ED visits and hospitalizations.We conclude that as more patients receive cancer therapy late in their disease trajectory,more cancer patients will visit EDs.Integration of PC with emergency medicine will require active participation of ED physicians in providing PC to cancer patients.PC specialist should play an active role in educating ED physicians about PC,and provide timely consultations.The impact of integrating PC in EDs on quality and cost of cancer care should be studied.展开更多
China's aging pressure is increasingly serious. The elderly people are difficult to seek medical advice,the elderly dependency ratio is soaring,finance fails to bear such heavy load,and social endowment service pr...China's aging pressure is increasingly serious. The elderly people are difficult to seek medical advice,the elderly dependency ratio is soaring,finance fails to bear such heavy load,and social endowment service pressure is also constantly increasing. Traditional endowment mode is already incapable of satisfying current endowment demands. On the basis of the population aging,this paper came up with the new endowment mode " hospital + nursing home" and analyzed its feasibility. Finally,it reached the conclusion that this endowment mode is helpful for solving problems of endowment and medical care,and alleviating the problem of population aging.展开更多
The collaboration of medical care,parenting,and education aims to integrate nursing,midwifery,infant and child care services,and management with speech and hearing rehabilitation technology,among other elements relate...The collaboration of medical care,parenting,and education aims to integrate nursing,midwifery,infant and child care services,and management with speech and hearing rehabilitation technology,among other elements related to the infant care industry chain.This integration targets pediatrics talent training in nine infant care positions,including nursing,infant health care and management,and child rehabilitation,to ensure that the capabilities and quality of professional talents can meet the health care needs of infants and young children.This article briefly explains the background of the“collaboration of medical care,parenting,and education,and integration of industry and education.”It analyzes the necessity of cultivating infant and child care service talents based on the perspective of“collaboration of medical care,parenting,and education,and integration of industry and education.”Based on this perspective,we conducted an in-depth study of the cultivation of professional qualities of infant and child care service talents.展开更多
Objective To explore the different modes and approaches of medical and preventive integration in current primary health care institutions in China.Methods Through literature analysis,field research,telephone interview...Objective To explore the different modes and approaches of medical and preventive integration in current primary health care institutions in China.Methods Through literature analysis,field research,telephone interviews,and other methods the implementation status was evaluated to systematically study the main experience and effect of implementing medical and preventive integration services in pilot areas.Results and Conclusion At present,there are three implementation modes of medical-prevention integration,namely,vertical mode based on the medical community,internal mode with optimized service process,and internal mode with great service capabilities.The three medical-prevention integration modes have their respective focuses,but they need to be further improved in terms of policy support,technical staffing,information system construction,and drug use.展开更多
BACKGROUND：In Shenzhen, the Emergency Medical Service （EMS） system has been in service since 1997. This study aims to examine the operation of Shenzhen 120 EMS center and to identify the reasons of calling EMS.BACK...BACKGROUND：In Shenzhen, the Emergency Medical Service （EMS） system has been in service since 1997. This study aims to examine the operation of Shenzhen 120 EMS center and to identify the reasons of calling EMS.BACKGROUND：In this retrospective quantitative descriptive study, the data from the Shenzhen 120 EMS registry in 2011 were analyzed.RESULTS：Shenzhen 120 EMS center is a communication command center. When the number of 120 are dialed, it is forwarded to the closest appropriate hospital for ambulance dispatch. In 2011, the Shenzhen 120 EMS center received 153 160 ambulance calls, with an average of 420 calls per day. Calling emergency services was mainly due to traffic accidents. Trauma and other acute diseases constituted a majority of ambulance transports. The adult patients aged 15-60 years are the principal users of EMS. There are no recognized ＇paramedic＇ doctors and nurses. The pre-hospital emergency service is under the operation of emergency departments of hospitals. Shenzhen at present does not have specialized pre-hospital training for doctors and nurses in posttrauma management. Moreover, specialized pre-hospital training, financial support, and public health education on proper use of EMS should be emphasized.CONCLUSION：The Shenzhen 120 EMS center has its own epidemiology characteristics. Traumatic injury and traffic accident are the main reasons for calling ambulance service. In-depth study emphasizing the distribution and characteristics of trauma patients is crucial to the future development of EMS.展开更多
The Aging Tsunami as it is often quoted to describe the worrying situations of rapidly aging in China has not met with detail planning in facilities upgrade and careful consideration in service models. Broad brushed c...The Aging Tsunami as it is often quoted to describe the worrying situations of rapidly aging in China has not met with detail planning in facilities upgrade and careful consideration in service models. Broad brushed central policies categorizes services into home care, community care and institutional care and set policy goals at 90-6-4, representing the percentage of older people in receiving respective care. This leaves local officials helpless on how these ideals can be actualized. Some cities have inclined to build huge older people homes and pour resources into institutional care, forgetting the need for older people to be connected with the society. This paper reviews the historical developments of older people services in Hong Kong and recommends an integrative model of social work services connecting institutional, community and home care into a seamless network. The city of Zhuhai will be presented as a perfect experimental city on how its existing facilities can be converted and developed according to the model. Survey on the situations of the 16 public older people homes will be used to illustrate the potentials of an integrative model.展开更多
Purpose: This study was conducted to clarify the utility of patient-held records as an integrated care approach for patients with dementia in the community. Method: We analyzed the family-held/patient-held records of ...Purpose: This study was conducted to clarify the utility of patient-held records as an integrated care approach for patients with dementia in the community. Method: We analyzed the family-held/patient-held records of patients with dementia in the community. The inclusion criteria in the study were as follows: 1) patient-held/family member-held records of patients with dementia in the community;2) patient-held records designed to share information across different professionals, direct-care staff members, and local government staff;and 3) the continuous participation of psychiatrists in the development and use of the patient-held records. Results: We identified eight sets of family-held/patient-held records in Japanese communities of various sizes, all of which were aimed at integrating information from various services, including information provided by medical and psychiatric professionals to the family and patient. Innovative tools have been available in the areas of the hopes and preferences of the patient, medication and monitoring, sharing information, and the use of information technology. Conclusion and Discussion: Family-held/patient-held records have potential as a tool to enhance the integrated care of people with dementia in the community.展开更多
文摘This study aimed to clarify the conditions surrounding fatigue that are common to medical professionals working in emergency and critical care centers in Japan. Semi-structured interviews were conducted with eight professionals ranging from doctors, nurses and pharmacists to clinical engineering technologists and radiation technologists. Their narratives were analyzed using the qualitative descriptive approach to determine fatigue common to all professionals and the reasons behind it. The five categories that emerged as the reasons for fatigue common to the subjects were [playing one’s role in treatment and procedures for emergency and critical patients], [accommodating the patient’s background and coming to terms with the outcome], [difficulties in liaising with other professionals], [feeling pressure as a responsible professional in emergency care] and [loss of sense of time caused by variable working hours]. The results revealed that fatigue common to all of the subjects was related to dealing with patients, coordinating with other professionals, having professional responsibilities and the working environment. This study suggests that arrangements to improve the working environment, ensure adequate staffing, and provide mental health support for the well-being of medical professionals working in emergency and critical care centers are necessary.
文摘Aim: The purpose of this study was to develop a scale, “parental anxiety about pediatric emergency medical care services” (PAPEMCS), and to evaluate its psychometric properties. Methods: Participants were 14,510 parents with children 6 years old or younger in Kagawa Prefecture. Using each half of the participants, exploratory factor analysis was performed to generate items and factors for the PAPEMCS, and confirmatory factor analysis (CFA) was used to establish the construct validity. The generalizability of the PAPEMCS was evaluated by congruence tests and multigroup CFA. The usefulness of the PAPEMCS was established by the relationship between the PAPEMCS and non-urgent usage of pediatric emergency medical care services (PEMCS). Results: The PAPEMCS compromised 4 factors: “anxiety about quality of PEMCS”, “anxiety about PEMCS system”, “anxiety about public support”, and “anxiety about private support”. All reliability estimates (polychoric ordinal alpha coefficients, item-rest correlations), the item discrimination, 5 fit indices for CFA, the convergent validity (indicator reliabilities, composite reliabilities, average variance extracteds), and the discriminant validity fulfilled the acceptability thresholds. All generalizability estimates fulfilled the predetermined levels of acceptability (Tucker’s congruence coefficients, congruence tests, strict factorial invariance). The usefulness of the PAPEMCS was established by the higher scores of the PAPEMCS being related to non-urgent usage of PEMCS. Conclusions: The PAPEMCS demonstrated satisfactory reliability, validity, generalizability and usefulness. The PAPEMCS is useful to quantify the contents and extent of parental anxiety about PEMCS, and to clarify the mechanisms of non-urgent PEMCS usage.
基金the 2021 General Project of Liaoning Department of Education(LJKR0125)the 2021 General Project of National Natural Science Foundation of China(52178011)+1 种基金the 2021 Liaoning Provincial Social Science Planning Fund Project(L21BRK003)the 2023 Research Topic on the Economic and Social Development of Liaoning Province(2023lslybkt-076).
文摘With the gradual intensification of aging in China,the issue of elderly care has become the primary issue that needs to be urgently solved in society.The construction of a reasonable and scientific integrated medical and care service system can not only efficiently allocate medical resources and services,but also better meet the needs of the elderly.Due to the involvement of multiple disciplines such as architecture,sociology,psychology,and behavioral science in the construction of the system,as well as the restriction of various objective factors such as medical capacity,spatial scale,and operating costs,the government and elderly care institutions have always been unable to find the best solution for how to scientifically and reasonably construct an integrated medical and care service system.This paper is based on Anshan City,Liaoning Province,which has prominent aging issues and distinct characteristics of the elderly population.Through extensive field research in elderly care institutions,and face-to-face communication with personnel from relevant government departments such as the Municipal Commission on Aging,the Civil Affairs Bureau,the Health Commission,the Medical Insurance Bureau,and the Human Resources and Social Security Bureau,it truly understands the problems that arise in the construction of the urban integrated medical and care service system.From three aspects:urban situation,institutional situation and the needs of the elderly,it is proposed to establish a clear departmental linkage mechanism with clear rights and responsibilities,a policy guarantee mechanism tailored to local conditions,a multi-measure operation mechanism,a technology first intelligent response mechanism,a warm and efficient service mechanism for the people,an overall layout mechanism,an evaluation and supervision mechanism for full process control,and a talent supply mechanism of external introduction and internal training.It aims to provide reference for the construction of an integrated medical and care service system in similar cities.
文摘Objective:To explore the clinical efficacy of the integrated medical care model combined with psychological intervention in pulmonary tuberculosis patients with lung cancer.Methods:From January to December 2022,60 pulmonary tuberculosis patients with lung cancer admitted to our hospital were selected as the research subjects.Using the random number table method,the patients were divided into two groups,a control group and a study group,with 30 cases in each group.The chest computed tomography(CT)examination results,mental state assessment(including depression scale and anxiety scale)scores,incidence of adverse reactions,treatment effect,and length of hospital stay were compared between the two groups.Results:The treatment effect of the patients in the study group was better than that of the patients in the control group(P<0.05);the duration of hospitalization,chest CT examination results,mental state assessment scores,and incidence of adverse reactions of the study group and the control group,were significantly different(P<0.05).Conclusion:The integrated medical care model combined with psychological intervention can effectively improve the treatment effect of pulmonary tuberculosis patients with lung cancer and prevent the occurrence of adverse reactions;thus,it should be promoted in clinical practice.
基金Baoding Science and Technology Plan Project“The Effect of Medical-Nurse Integrated Nursing Model Combined with Psychological Intervention on the Clinical Curative Effect of Tuberculosis and Lung Cancer Patients”(Project number:2141ZF318).
文摘Objective:To explore the effect of integrated medical and nursing care in patients with pulmonary tuberculosis combined with lung cancer.Methods:From August 2021 to August 2022,60 patients with pulmonary tuberculosis combined with lung cancer were admitted.All patients were diagnosed with pulmonary tuberculosis according to the Guidelines for the Diagnosis and Treatment of Pulmonary Tuberculosis and with lung cancer by pathology.The patients were randomly divided into two groups,with 30 cases in each group.The control group received daily nursing care,whereas the study group received integrated medical and nursing care.The sputum conversion rate,tumor remission rate,and quality of life of patients were observed and analyzed.Results:The item function score and symptom function score of the observation group were higher than those of the control group(P<0.05);the total effective rate of the observation group was significantly higher than that of the control group(P<0.05);the sputum conversion rate of the observation group was significantly higher than that of the control group(P<0.05).Conclusion:For patients with pulmonary tuberculosis combined with lung cancer,the application of integrated medical and nursing care can help consolidate the treatment effect and improve the quality of life of patients;thus,it is worthy of promotion and application.
文摘BACKGROUND： Beijing successfully hosted the 2008 Olympic Games, and the servicesincluding medical services were widely appreciated by both participants and visitors. Weretrospectively analyzed the quality of the medical services provided to athletes, spectators, VIPs,and the workforce during the Beijing 2008 Olympic Games. The information thus gathered would beuseful for planning strategies for managing mass gatherings.METHODS： Medical encounter forms filled during the Beijing 2008 Olympic Games wereretrospectively reviewed. Descriptive statistics was used to characterize the data by accreditation anddiagnostic categories.RESULTS： A total of 22 892 medical encounters were documented during the Beijing 2008Olympic Games. Among them, 10 549 （46.08%） involved the workforce, 3 365 （14.70%） athletes,3 019 （13.19%） spectators, 585 （2.56%） members of the media, 1 065 （4.65%） VIPs, and 4 309（18.82%） others. Of the 22 892 cases, physical injury accounted for 27.90% （6 386）, respiratorydisease 18.21% （4 169）, and heat-related illnesses 2.68% （615）.CONCLUSIONS： Preparations of the medical service for the Beijing 2008 Olympic Gameswere made for 7 years, and the service provided has been praised worldwide. This study providesvaluable information that may be useful for planning medical services for upcoming Olympic Games,including the London 2012 Olympic Games and other mass gatherings.
文摘AIM To determine if our health system's integrated model reflects sustained virologic response(SVR) outcomes similar to those in clinical trial data, maximizes adherence, and averts drug interactions.METHODS Subjects with chronic hepatitis C had their medical records reviewed from November 1st, 2014 through March 1st, 2016. Patients eligible for treatment were entered into an integrated care model therapy algorithm. The primary outcome was SVR12 based on intention to treat(ITT) analysis. Inclusion criteria consisted of both treatment na?ve and experienced patients over the age of 18 who were at least twelve weeks post-therapy completion with any genotype(GT) or METAVIR score. Secondary outcomes included adherence, adverse events, and number of drug interaction interventions.RESULTS At the time of analysis, 133 patients had reached twelve weeks post therapy with ITT. In the ITT analysis 70 patients were GT 1a, 26 GT 1b, 23 could not be differentiated between GT 1a or 1b, 8 GT 2, 4 GT 3, and 2 patients with multiple genotypes. The ITT treatment regimens consisted of 97 sofosbuvir(SOF)/ledipasvir(LDV), 8 SOF/LDV and ribavirin(RBV), 7 SOFand Simeprevir(SMV), 6 3D and RBV, 1 3D, 11 SOF and RBV, and 1 SOF, peg interferon alpha, and RBV. The overall SVR12 rate was 93% in the ITT analysis with a total of 6 patients relapsing. In patients with cirrhosis, 89% obtained SVR12. All 33 patients who were previous treatment failures achieved SVR12. Drug-drug interactions were identified in 56.4% of our patient population, 69 of which required interventions made by the pharmacist. The most common side effects were fatigue(41.4%), headache(28.6%), nausea(18.1%), and diarrhea(8.3%). No serious adverse effects were reported.CONCLUSION Dean Health System's integrated care model successfully managed patients being treated for hepatitis C virus(HCV). The integrated care model demonstrates high SVR rates amongst patients with different levels of fibrosis, genotypes, and HCV treatment history.
文摘Point of care ultrasonography(POCUS)has evolved to become the fifth pillar of the conventional physical examination,and use of POCUS protocols have significantly decreased procedure complications and time to diagnose.However,lack of experience in POCUS by preceptors in medical schools and nephrology residency programs are significant barriers to implement a broader use.In rural and low-income areas POCUS may have a transformative effect on health care management.
文摘Although visiting the emergency departments(EDs) is considered poor quality of cancer care,there are indications these visits are increasing.Similarly,there is growing interest in providing palliative care(PC) to cancer patients in EDs.However,this integration is not without major challenges.In this article,we review the literature on why cancer patients visit EDs,the rates of hospitalization and mortality for these patients,and the models for integrating PC in EDs.We discuss opportunities such integration will bring to the quality of cancer care,and resource utilization of resources.We also discuss barriers faced by this integration.We found that the most common reasons for ED visits by cancer patients are pain,fever,shortness of breath,and gastrointestinal symptoms.The majority of the patients are admitted to hospitals,about 13% of the admitted patients die during hospitalization,and some patients die in ED.Patients who receive PC at an ED have shorter hospitalization and lower resource utilization.Models based solely on increasing PC provision in EDs by PC specialists have had modest success,while very limited ED-based PC provision has had slightly higher impact.However,details of these programs are lacking,and coordination between ED based PC and hospitalwide PC is not clear.In some studies,the objectives were to improve care in the communities and reduce ED visits and hospitalizations.We conclude that as more patients receive cancer therapy late in their disease trajectory,more cancer patients will visit EDs.Integration of PC with emergency medicine will require active participation of ED physicians in providing PC to cancer patients.PC specialist should play an active role in educating ED physicians about PC,and provide timely consultations.The impact of integrating PC in EDs on quality and cost of cancer care should be studied.
基金Supported by Key Project for Social Sciences of Chongqing Municipal Education Commission(14SKI02 and 14SKS10)Project of National Social Science Foundation(12BSH071)
文摘China's aging pressure is increasingly serious. The elderly people are difficult to seek medical advice,the elderly dependency ratio is soaring,finance fails to bear such heavy load,and social endowment service pressure is also constantly increasing. Traditional endowment mode is already incapable of satisfying current endowment demands. On the basis of the population aging,this paper came up with the new endowment mode " hospital + nursing home" and analyzed its feasibility. Finally,it reached the conclusion that this endowment mode is helpful for solving problems of endowment and medical care,and alleviating the problem of population aging.
文摘The collaboration of medical care,parenting,and education aims to integrate nursing,midwifery,infant and child care services,and management with speech and hearing rehabilitation technology,among other elements related to the infant care industry chain.This integration targets pediatrics talent training in nine infant care positions,including nursing,infant health care and management,and child rehabilitation,to ensure that the capabilities and quality of professional talents can meet the health care needs of infants and young children.This article briefly explains the background of the“collaboration of medical care,parenting,and education,and integration of industry and education.”It analyzes the necessity of cultivating infant and child care service talents based on the perspective of“collaboration of medical care,parenting,and education,and integration of industry and education.”Based on this perspective,we conducted an in-depth study of the cultivation of professional qualities of infant and child care service talents.
基金Source of the project:the Social Science Planning Fund Project of Liaoning Province(L19BG034)the Philosophy and Social Science Planning Key Project of Shenyang City(SZ202001L)the Key Project of Shenyang Social Science Funding(SYSK2020-04-01).
文摘Objective To explore the different modes and approaches of medical and preventive integration in current primary health care institutions in China.Methods Through literature analysis,field research,telephone interviews,and other methods the implementation status was evaluated to systematically study the main experience and effect of implementing medical and preventive integration services in pilot areas.Results and Conclusion At present,there are three implementation modes of medical-prevention integration,namely,vertical mode based on the medical community,internal mode with optimized service process,and internal mode with great service capabilities.The three medical-prevention integration modes have their respective focuses,but they need to be further improved in terms of policy support,technical staffing,information system construction,and drug use.
文摘BACKGROUND：In Shenzhen, the Emergency Medical Service （EMS） system has been in service since 1997. This study aims to examine the operation of Shenzhen 120 EMS center and to identify the reasons of calling EMS.BACKGROUND：In this retrospective quantitative descriptive study, the data from the Shenzhen 120 EMS registry in 2011 were analyzed.RESULTS：Shenzhen 120 EMS center is a communication command center. When the number of 120 are dialed, it is forwarded to the closest appropriate hospital for ambulance dispatch. In 2011, the Shenzhen 120 EMS center received 153 160 ambulance calls, with an average of 420 calls per day. Calling emergency services was mainly due to traffic accidents. Trauma and other acute diseases constituted a majority of ambulance transports. The adult patients aged 15-60 years are the principal users of EMS. There are no recognized ＇paramedic＇ doctors and nurses. The pre-hospital emergency service is under the operation of emergency departments of hospitals. Shenzhen at present does not have specialized pre-hospital training for doctors and nurses in posttrauma management. Moreover, specialized pre-hospital training, financial support, and public health education on proper use of EMS should be emphasized.CONCLUSION：The Shenzhen 120 EMS center has its own epidemiology characteristics. Traumatic injury and traffic accident are the main reasons for calling ambulance service. In-depth study emphasizing the distribution and characteristics of trauma patients is crucial to the future development of EMS.
文摘The Aging Tsunami as it is often quoted to describe the worrying situations of rapidly aging in China has not met with detail planning in facilities upgrade and careful consideration in service models. Broad brushed central policies categorizes services into home care, community care and institutional care and set policy goals at 90-6-4, representing the percentage of older people in receiving respective care. This leaves local officials helpless on how these ideals can be actualized. Some cities have inclined to build huge older people homes and pour resources into institutional care, forgetting the need for older people to be connected with the society. This paper reviews the historical developments of older people services in Hong Kong and recommends an integrative model of social work services connecting institutional, community and home care into a seamless network. The city of Zhuhai will be presented as a perfect experimental city on how its existing facilities can be converted and developed according to the model. Survey on the situations of the 16 public older people homes will be used to illustrate the potentials of an integrative model.
文摘Purpose: This study was conducted to clarify the utility of patient-held records as an integrated care approach for patients with dementia in the community. Method: We analyzed the family-held/patient-held records of patients with dementia in the community. The inclusion criteria in the study were as follows: 1) patient-held/family member-held records of patients with dementia in the community;2) patient-held records designed to share information across different professionals, direct-care staff members, and local government staff;and 3) the continuous participation of psychiatrists in the development and use of the patient-held records. Results: We identified eight sets of family-held/patient-held records in Japanese communities of various sizes, all of which were aimed at integrating information from various services, including information provided by medical and psychiatric professionals to the family and patient. Innovative tools have been available in the areas of the hopes and preferences of the patient, medication and monitoring, sharing information, and the use of information technology. Conclusion and Discussion: Family-held/patient-held records have potential as a tool to enhance the integrated care of people with dementia in the community.
