Hospitals In Zhejiang Province Research Articles

Investigation of relationships among nurse work environment, organizational commitment and intent to stay

Objective To investigate the status of the nurse work environment, organizational commitment and intent to stay, and explore the relationships among them, ultimately provide some references for the managers. Methods 1 168 registered nurses were recruited from seven hospitals in Zhejiang province. They were investigated with Nursing Work Environment Scale, Organizational Commitment Scale and Intent to Stay Scale. Multiple regression analysis utilized the intent to stay of nurses as the dependent variable, and the demographic data, the dimensions of work environment and dimensions of organizational commitment as the independent variables. Results The mean scores of work environment, organizational commitment and intent to stay were 2.78±0.39, 2.42±0.43, 3.30±0.67, respectively. Among nurse work environment, organizational commitment and intent to stay, there was a significant positive correlation between any two of them. Duty, affective commitment, position of work, sufficient manpower and resources, normative commitment, leadership and ability of manager, gender, shift, housing condition (rent house), employment nature and education are the main factors for the intent to stay, which can explain 40.3% of the variations of nurse retention. Conclusions The results of the study showed that the nurse work environment and intent to work of the 1168 registered nurses were at a medium level, and the organization′s commitment was at a lower-middle level. Managers can refer to the factors affecting the intent of nurses to stay, develop retention strategies, and increase their intent to stay. Key words: Nursing services; Environment; Organizational commitment; Intent to stay; Health manpower

Survey on the use of glucocorticoids in severe community-acquired pneumonia in intensive care unit of forty-five hospitals in Zhejiang Province

To investigate the use of glucocorticoids in patients with severe community-acquired pneumonia (SCAP) in the intensive care unit (ICU) of Hospitals in Zhejiang Province and to provide a reference for guiding clinical use of SCAP patients. To draw up a questionnaire with reference to the Chinese and international guidelines, and to investigate the knowledge of community-acquired pneumonia (CAP) related guidelines and the use of glucocorticoids in patients with SCAP by doctors in hospitals above secondary level in Zhejiang Province by Email. Then the valid questionnaire was analyzed. In June 2016, 340 questionnaires were distributed, and all were returned after 2 months, with 333 of valid; 333 doctors from 45 ICUs in Zhejiang Province participated in the survey. (1) The knowledge of CAP-related guidelines in ICU doctors: 79.58% (265/333) of the doctors had read the CAP guidelines, and those who work over 10 years had a higher reading rate than those with 1-5 years and 6-10 years [93.07% (94/101) vs. 74.00% (111/150), 73.17% (60/82), both P < 0.05]. Post-graduates and above had higher reading rates than undergraduates [85.35% (134/157) vs. 74.43% (131/176), P < 0.05]. Senior doctors had higher reading rates than the junior and intermediate doctors [93.07% (94/101) vs. 71.43% (80/112), 75.83% (91/120), both P < 0.05]. The rate of understanding the clinical application of glucocorticoids was 13.81% (46/333). The doctors who work over 10 years and the seniorshad a relatively high awareness rate, 23.76% (24/101) and 20.79% (21/101) respectively. However, there was no significant difference in the awareness rate between doctors with different degrees and different levels of hospitals. (2) For the use of glucocorticoids in different causes of pneumonia, 44.74% (149/333) of doctors routinely used glucocorticoids in severe viral pneumonia. The proportion of glucocorticoids used in severe bacterial pneumonia, severe fungal pneumonia, severe pneumocystis pneumonia, chronic obstructive pulmonary disease (COPD) and severe pneumonia were 22.82% (76/333), 9.31% (31/333), 22.52% (75/333) and 18.32% (61/333), respectively. (3) The way of glucocorticoid usage: 79.58% (265/333) of doctors chose methylprednisolone, 4.20% (14/333) chose hydrocortisone, 1.20% (4/333) chose dexamethasone, and 15.02% (50/333) had not use glucocorticoids. The proportion of physicians who chose to use glucocorticoids within 24 hours of admission and 1-7 days after admission were 52.65% (149/283) and 47.35% (134/283), respectively. Glucocorticoids were used more in doctors with lower academic qualifications and hospitals within 24 hours. The undergraduate degree was 61.39% (97/158), and the second-grade class hospital was 67.50% (27/40). Among the doctors who chose methylprednisolone, 60.75% (161/265) prescribe the dose ≤ 80 mg/d; 79.15% (224/283) chose the course of ≤ 7 days. The number of years of work, education, professional title and hospital grade had no significant effect on the choice of methylprednisolone and the course of treatment. ICU doctors of 45 hospitals in Zhejiang Province have a high degree of heterogeneity in the understanding of the use and guidelines of glucocorticoids in SCAP. It is necessary to strengthen the ICU doctor's study of clinical guidelines at home and abroad and to develop a glucocorticoid use plan according to the specific conditions of patients, so that SCAP patients can benefit more.

Research on the current situation of public health services compensation at public hospitals in Zhejiang province

Objective To explore the financial compensation strategy on the basis of understanding the current situation of compensation for public health services at public hospitals in Zhejiang province. Methods From July to October, 2017, an interview survey was conducted at 23 public hospitals in 7 cities in Zhejiang province to understand the current situation of financial compensation for public health services at public hospitals. At the same time, the data of income and expenditure in 2016 of every hospital were collected and analyzed by the methods of descriptive statistics. Results The average proportion of financial subsidies at the 23 public hospitals in 2016 was 6.29%, of which public health special subsidy accounted for 0.44% of total hospital revenues. Only 9 of the 23 hospitals had surplus in 2016, accounting for 39.13%. Conclusions The public health services compensation mechanism of public hospitals in Zhejiang province calls for further reforms. The government departments should comprehensively formulate financial compensation policies at the provincial level according to the public health assignments and call into play a variety of compensation methods, to establish a long-term assessment mechanism and ensure that public hospitals can proactively carry out public health services. Key words: Hospitals, public; Public health services; Financial compensation; Strategy; Zhejiang province

Carbapenem-Resistant Hypervirulent ST11 &lt;i&gt;Klebsiella Pneumoniae &lt;/i&gt;Colonization in Zhejiang, China: An Epidemiological, Genomic and Functional Study

The co-occurrence of hypervirulence and KPC-2 carbapenem resistant phenotypes in a highly-transmissible ST11 clone of Klebsiella pneumoniae has elicited a deep concern from public health and social communities. To address this puzzle, we conducted a large-scale epidemiological, clinical and genomic study of K. pneumonia ST11 clones with both hypervirulence and carbapenam resistance in two tertiary hospitals in Zhejiang Province. The majority of the patients (16/24) were diagnosed to be infected with exclusively carbapenem-resistant K. pneumoniae (CRKP) while eight cases had mixed infections. Consequently, ten death cases were recorded, some of which were due to a failure to respond to antibiotic therapies. We identified two new rare sequence types (ST437 & ST449) to KPC-2-producing CRKP, in addition to the dominant ST11. These clinical isolates of K. pneumoniae are multi-drug resistant, and heterogeneous in virulence factor profiles. Experimental infections of wax moth larvae suggested that they are in various level of hypervirulence. Moreover, we completed full genome sequencing of 23 plasmids comprising 13 rmpA2-positive virulence plasmids and 10 blaKPC-2-harboring resistance plasmids. In addition to the prevalent pLVKP-like virulence plasmid variants (~178kb), we found an unexpected diversity among KPC-2-producing plasmids whose dominant form is IncFII-IncR type (~120kb), rather than the previously-anticipated version of ~170kb. Additionally, we are first to report a novel blaKPC-2-carrying ~9.8kb mini-plasmid, designated pK186-KPC. These findings illustrate a more comprehensive picture of convergence of hypervirulence and carbapenem resistance in ST11 K. pneumoniae, providing extensive genomic insights into the diversity of dominant clones in Zhejiang Province. Funding Statement: This work was supported by National Natural Science Foundation of China (31830001, 31570027 & 81772142, YF and 81873946, MH), and National Key R&D Program of China (2017YFD0500202, YF). Declaration of Interests: The authors declare that no conflict of interest is present. Ethics Approval Statement: Clinical data were recorded and approved by the local ethics committee from both the Second Affiliated Hospital, Zhejiang University School of Medicine (2018-01-F) and the Lishui People’s Hospital (2017-005-01).

Prevalence and determinants of latent tuberculosis infection among frontline tuberculosis healthcare workers in southeastern China: A multilevel analysis by individuals and health facilities

ObjectivesHealthcare workers (HCWs) are at high risk of latent tuberculosis infection (LTBI), and the baseline prevalence of LTBI among frontline TB HCWs in southeastern China remains unknown. The aim of this study was to assess the prevalence of LTBI among TB HCWs and to analyze factors associated with LTBI at both the individual and institutional level. MethodsBased on a cross-sectional study design, 31 out of 89 TB-designated hospitals in Zhejiang Province of China were selected. Information on TB infection control measures was collected through field visits to each of the selected hospitals. All TB HCWs from the selected hospitals were recruited to answer a questionnaire and to undergo LTBI testing by TB interferon gamma release assay. Univariate analyses and a generalized linear mixed model were applied to analyze factors associated with LTBI at both the individual and hospital level. ResultsA total of 487 TB HCWs were recruited at the 31 TB-designated hospitals; 33.9% of them tested positive for LTBI. At the institutional level, a low TB epidemic level, regular infection control training for HCWs, and regular maintenance of ultraviolet disinfection equipment were found to be significantly associated with a lower LTBI rate among HCWs. At the individual level, alcohol use, a greater number of years working on TB, and a longer weekly duration of contact with TB patients were identified as associated factors for LTBI among HCWs. ConclusionsThe LTBI rate among frontline TB HCWs was found to be high in southeastern China. Factors at the institutional and individual level could both affect the prevalence of LTBI among HCWs.

Evaluation of a quantitative serum Aspergillus fumigatus-specific IgM assay for diagnosis of chronic pulmonary aspergillosis.

The early diagnosis of chronic pulmonary aspergillosis (CPA) remains challenging. Currently, a new quantitative IgM antibody assay that enveloped purified galactomannan extracted from Aspergillus fumigatus as antigen was commercially available in China, but its diagnostic value remains to be established. To evaluate the role of this commercial IgM assay for diagnosis of CPA, a multi-center prospective study was performed in 12 hospitals in Zhejiang Province, from January 1 to December 31, 2016. Adult inpatients without severe immunocompromised condition and those with persistent clinical symptoms/radiological findings ≥3 months or a consistent appearance in chest CT that was suggestive of CPA were included. The clinical data were compiled using a structured questionnaire. A total of 87 cases were enrolled, including 43 CPA. The sensitivity ranged from 16.3% to 46.5%, and the specificity from 77.3% to 95.5% when cutoffs were from 50 to 80 arbitrary unit (AU)/mL. The receiver operating characteristic analysis revealed an area under the curve of 0.627. When a cutoff of 38.12 AU/mL was applied, the sensitivity and specificity were 69.8% and 56.8%, respectively, which represents the best performance. To our knowledge, this study was the first to evaluate this commercial A. fumigatus-specific IgM antibody assay in CPA patients in China and indicates that this IgM assay has a limited value and should not be a prior recommendation for CPA diagnosis.

A randomised controlled trial of the effectiveness of a breastfeeding training DVD on improving breastfeeding knowledge and confidence among healthcare professionals in China

BackgroundDespite almost all babies being breastfed initially, the exclusive breastfeeding rate at six months is less than 30% in China. Improving professionals’ knowledge and practical skill is a key government strategy to increase breastfeeding rates. This study aimed to test the effectiveness of a breastfeeding DVD training method for clinicians on improving their knowledge and confidence in the breastfeeding support skills of teaching mothers Positioning and Attachment (P & A) and Hand Expression (HE).MethodsA randomised controlled trial was conducted in three hospitals in Zhejiang province, China in 2014. Participants were recruited before their routine breastfeeding training course and randomly allocated to intervention group (IG) and control group (CG). The 15 min “Breastfeeding: Essential Support Skills DVD” was the intervention for IG and a vaginal delivery DVD was used for CG. All participants completed questionnaires of job information, knowledge and confidence in the two skills before (baseline) and immediately after viewing the DVD (post DVD).ResultsOut of 210 participants, 191 completed knowledge assessments before and after watching the DVD (IG n = 96, CG n = 95), with the response rate of 91.0%. At baseline, there are no significant differences in job variables, total knowledge scores and confident scores. The total knowledge score significantly increased post-DVD for IG (pre-DVD: M = 5.39, SD = 2.03; post-DVD: M = 7.74, SD = 1.71; t (95) = − 10.95, p < 0.01), but no significant change in total knowledge score for CG between pre- and post-DVD (pre-DVD: M = 5.67, SD = 1.70; post-DVD: M = 5.56, SD = 1.63; t (94) = 0.85). The total confidence scores were significantly higher post-DVD than pre-DVD in IG (pre-DVD: M = 66.49, SD = 11.27; post- DVD: M = 71.81, SD = 9.33; t (68) = − 4.92, p < 0.01), but no significant difference was seen in CG between pre- and post-DVD total confidence scores (pre-DVD: M = 68.33, SD = 11.08; post-DVD: M = 68.35, SD = 11.40; t (65) = − 0.25). Personal and job variables did not mediate these effects.ConclusionsThe breastfeeding training DVD improved professionals’ knowledge and confidence of the two breastfeeding support skills. However, the effect on professionals’ practice and on breastfeeding outcomes needs to be examined in the future.

Exploring women’s decisions about childbearing after the lifting of the one-child policy

In 2016, China officially ended the ‘one-child’ policy permitting all couples to have two children for the first time since 1979. While the policy was relaxed due to demographic concerns, it simultaneously provided many women with a new reproductive opportunity. The goal of this study was to qualitatively understand the childbearing decision process in the new era of the two-child policy. We conducted in-depth, semi-structured interviews with 45 postpartum women at two hospitals in Zhejiang Province, China. The interviews explored women’s views on the two-child policy and reproductive decisions and how they decided to have their first or second child. Most women approved of the lifting of the one-child policy; however, many were hesitant or uncertain about their own decisions to have second children. Many felt pressured to have two children for the good of, or as an obligation to, the family. However, they also felt that caring for two children was burdensome, and that they would have to sacrifice a lot in terms of freedom, energy and money. Their responses to the new reproductive opportunity highlight the complexity of childbearing decision-making in modern Chinese society, against a background of persisting traditional values.

Effect of leader-member exchange on nurses'sense of calling in workplace

Objective: To investigate the effect of leader-member exchange on nurses'sense of calling in workplace based on self-determination theory. Methods: A total of 381 nurses were randomly selected from five tertiary general hospitals in Zhejiang province, China from October to December, 2016. They were subjected to a survey using the Leader-Member Exchange Scale, Job Autonomy Scale, Core Self-Evaluation Scale, and Calling Scale. The mediating effect was used to test the procedures and the data were subjected to hierarchical regression analysis. Results: The leader-member exchange was positively correlated with job autonomy, core self-evaluation, and sense of calling (r=0.471, P<0.001; r=0.373, P<0.001; r=0.475, P<0.001) ; the leader-member exchange had a positive predictive effect on job autonomy and sense of calling (β= 0.47, P<0.001; β=0.48, P<0.001) ; the job autonomy had a partial mediating effect on the relationship between leader-member exchange and sense of calling (F=66.50, P<0.001) ; the core self-evaluation negatively adjusted the positive relationship between leader-member exchange and job autonomy (F=27.81, P<0.001) . Conclusion: High-quality leader-member exchange enhances the sense of calling by improving staffs' job autonomy and the core self-evaluation reduces the positive relationship between leader-member exchange and job autonomy.

A cross-sectional study on current status of the nutritional support for patients with severe traumatic brain injury in Zhejiang province

Objective To study the current status of the nutritional support for patients with severe traumatic brain injury in Zhejiang province. Methods A total of 219 patients in 24 hospitals in Zhejiang province were enrolled from October 2015 to December 2016 in this study. All the clinical information of these patients after arriving at hospital were recorded, as well as the contents and complications of nutritional support after injury. All patients were followed up , and their Glasgow Outcome Scale were evaluated and recorded. Results A majority of patients in this study obtained early nutritional support after the injury, which accounted for 99.06% of all cases on the 7th day post injury. The percentage of enteral nutrition was relatively high. Within 30 days post injury, the average ratio of actual calorie supplementation to the target of calorie supplementation had increased from (42.8±34.1)% to (85.5±27.7)% (P 0.05). At 6-month follow-up post injury, good outcomes were achieved in 113 cases, poor outcomes occurred in 89 cases, and 17 cases died. Subgroup analysis indicated that patients with inadequate calorie supplementation within 7 days post injury had poorer outcomes at 6-month follow-up compared with patients with adequate calorie supplementation (χ2=8.354, P<0.05). Multiple complications such as nausea and vomiting were observed and related to nutritional support, among them the most common form was hyperglycemia with the incidence rate of 0.5%~13.7%. Conclusion Early and diverse nutritional support has been provided for patients with severe traumatic brain injury in Zhejiang province. However, the rate of adequate calorie and protein supplementation seems critically low. Key words: Craniocerebral trauma; Nutritional support; Questionnaires; Multicenter studies

Study on relationship between posttraumatic stress disorder and nurses′ psychological capital

Objective To explore the relationship between posttraumatic stress disorder and nurses′ psychological capital. Methods By convenient sampling, totally 550 nurses in 5 first-class upper level general hospitals in Zhejiang province were investigated by the posttraumatic stress disorder (PTSD)Cheeklist-Civilan Version (PCL-C) and Nurses Psychological Capital Questionnaire Revision (NPCQR), and the results were analyzed. Results 18.35% investigated nurses showed a certain degree of PTSD symptoms and 13.71% showed obvious PTSD symptoms. The positive rate was 32.06%.The overall score of nurses′ psychological capital was 78.81 ± 16.54, which was in the middle level, and the dimension scores from high to low were self-efficacy (23.80±5.35), hope (23.36±5.24), resilience (19.66 ±4.29), and optimism (11.99 ± 3.21). The nurses′ psychological capital had a negative effect on posttraumatic stress disorder (P<0.01). Conclusions Psychological capital of nurses is a negative predictor of PTSD symptoms, which suggested that managers should pay more attention to the development of nurses′psychological capital to reduce and prevent the occurrence of posttraumatic stress disorder,then to improve nursing service quality. Key words: Nurses; Posttraumatic stress disorder; Psychological capital

Effect of occupational exposure on job burnout in nurses

Objective: To investigate the effect of occupational exposure on job burnout in nurses, and to analyze the mediating effect of negative emotion between occupational exposure and job burnout and the regulatory effect of supervisor support on occupational exposure and negative emotion. Methods: From September to December, 2015, simple random sampling was used to select 543 nurses from six tertiary hospitals in Zhejiang Province, China. The questionnaires consisted of occupational exposure risk questionnaire, negative emotion questionnaire, supervisor support questionnaire, and job burnout questionnaire. Results: The total score of occupational exposure risk in nurses was 11.43±7.19; the score of emotional exhaustion was 3.19±1.24, the score of low sense of personal accomplishment was 3.02±1.21, and the score of sense of working indifference was 2.24±1.06. There were significant differences in occupational exposure score between nurses with different sexes (t=2.61, P<0.01) and working years (F=4.49, P<0.01) . There were significant differences in the scores of emotional exhaustion and low sense of personal accomplishment in nurses with different sexes (t=5.25, P<0.001) and working years (t=-3.48, P<0.01) . Occupational exposure had positive effects on negative emotion (β=0.41, P<0.05) , emotional exhaustion (β=0.47, P<0.05) , sense of working indifference (β=0.42, P<0.05) , and low sense of personal accomplishment (β=0.17, P<0.05) . Negative emotion had a partial mediating effect between occupational exposure and emotional exhaustion (total effect size 30.5%, P<0.05) and between occupational exposure and sense of working indifference (total effect size 37.1%, P<0.05) . Negative emotion had a complete mediating effect between occupational exposure and low sense of personal accomplishment (β=0.08, P>0.05) . Supervisor support negatively regulate the effects of occupational exposure and negative emotion (F=21.73, P<0.001) . Conclusion: In nurses, occupational exposure has a direct positive effect on job burnout and indirectly influences job burnout via negative emotion. Supervisor support can reduce the negative impact of occupational exposure on negative emotion.

Discussion of the subsidy mechanism of public hospitals in Zhejiang province

Analyzed in the paper is the current subsidy mechanism for public hospitals in Zhejiang province, with analysis of problems found.The authors recommended to build a mass fraction subsidy mechanism to cover up the insufficiency of government financial subsidy; to fully leverage the price compensation of medical services; to subsidize in view of the functional positioning of various medical institutions; and explore more channels for public hospitals′ subsidies. Key words: Zhejiang province; Public hospital; Subsidy mechanism; Problems

Reform of public hospitals in Zhejiang province: practice and policy options

Described in the paper is the reform made at public hospitals in Zhejiang province, with analysis of its problems and causes.Based on such, the authors proposed the following actions: to accelerate the reform of public hospitals centering on health promotion, and encourage such hospitals to shoulder the health care responsibility on behalf of the government; to proceed with hierarchical medical system and contract-based service focusing on capacity building of general practitioners; to attract private capital into building the healthcare system; and to motivate non-governmental organizations to cater to diversified healthcare needs of the people. Key words: Zhejiang province; Public hospital; Reform; Centering on health promotion

A multicenter confirmatory study about precision and practicability of Sepsis-3

To clinically validate the precision of diagnostic Sepsis-3 criteria, and to guide and generalize its clinical application. A multicenter retrospective observational study was conducted. The patients admitted to intensive care unit (ICU) of 6 tertiary hospitals in Zhejiang Province from January to June 2015 were enrolled, and the patients satisfying the diagnostic criteria of Sepsis-2 and Sepsis-3 were screened. Population characteristics between the patients satisfying two editions were compared, and the diagnosis accuracy rate in different degree hospitals were investigated. According to the doctor's diagnosis, the patients who met the criteria of Sepsis-2 were divided into diagnosis group and non-diagnosis group, and the factors influencing the diagnosis of sepsis were analyzed by logistic regression. The patients meeting Sepsis-2 but no meeting Sepsis-3 were served as exclusion group, and those meeting Sepsis-2 and Sepsis-3 were served as enroll group, and the characteristics of patients between the two groups were compared. Receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of systemic inflammatory response syndrome (SIRS) score, sepsis-related quick sequential organ failure assessment (qSOFA) and sequential organ failure assessment (SOFA) on death, and whether the consistency of qSOFA and SOFA would affect the sensitivity of definition. The patients meeting Sepsis-2 were divided into non-survived group and survived group, and the factors associated with death were analyzed by logistic regression. Finally, 1 423 patients were enrolled, 3 patients with age < 18 years and 19 patients with missing data were excluded. There were 363 patients and 329 patients met Sepsis-2 and Sepsis-3, respectively. No significant differences were found in population characteristics between the groups of Sepsis-2 and Sepsis-3 (all P > 0.05) except for acute physiology and chronic health evaluation II (APACHE II) score [19.10 (8.00) vs. 20.28 (8.00), P < 0.05]. It was shown on the clinical data analysis of the hospitals that the patients meeting Sepsis-2 and Sepsis-3 in hospital 3 had the highest 28-day mortality (60.4% and 60.0%) with the lowest rate of diagnosis (0). While in the hospital 1, the patients had the lowest 28-day mortality (22.9% and 27.2%), and the rate of diagnosis was 19.5%. Interestingly, the patients in hospital 4 had the highest diagnosis rate of sepsis (44.8%), but 28-day mortality was both 58.6%. It was shown by logistic regression analysis that the patients with old age [odds ratio (OR) = 0.970, P = 0.021], high blood lactate (OR = 0.443, P = 0.004), high blood pressure (OR = 0.957, P = 0.009) and low oxygenation index (OR = 1.004, P = 0.024) were easy to neglect diagnosis. Compared with Sepsis-3 exclude group, the patients in Sepsis-3 enroll group were older [years: 68.52 (26.00) vs. 53.75 (18.00), P < 0.01] with higher APACHEII score [20.38 (8.00) vs. 7.72 (6.00), P < 0.01], higher blood lactate [mmol/L: 3.45 (3.00) vs. 1.95 (1.20), P > 0.05], longer length of ICU stay [days: 22.42 (22.00) vs. 15.13 (16.00), P < 0.01], and higher 28-day mortality [45.29% (149/329) vs. 14.71% (5/34), P < 0.01], indicating that the diagnostic efficiency of Sepsis-2 was low, the diagnostic specificity of Sepsis-3 was high, and the prognosis of Sepsis-3 patients was worse. It was shown by ROC curve analysis that the prognostic value of SIRS, qSOFA and SOFA to mortality was gradually increased [area under ROC curve (AUC) was 0.567, 0.597, 0.683, respectively], but the prognostic value were all low. Comparing patients meeting qSOFA and (or) SOFA in Sepsis-2, significant differences were found in APACHE II score [17.55 (7.00) vs. 23.24 (8.00)] and 28-day mortality [38.75% (31/80) vs. 58.59% (75/128), both P < 0.01]. The patients who just met the qSOFA or SOFA, their 28-day mortality was up to 38.75%, suggesting that qSOFA should not be ignored. Compared with survived group, the patients in survived group were older with higher APACHE II score and shorter length of ICU stay (all P < 0.05). It was shown by logistic regression analysis that APACHE II score (OR = 1.199, P = 0.000) and length of ICU stay (OR = 0.949, P = 0.000) were related with death. Patients satisfied Sepsis-3 were easier to develop more organ failure, Sepsis-3 and higher death prediction than Sepsis-2 and higher diagnosis specificity, but data shows that there is extra room for improvement.

Therapeutic strategies based on clinical big data of antibiotic resistance monitoring of Helicobacter pylori in Zhejiang province

Objective To combine clinical big data and precision medicine by investigating the antibiotic resistance rates of Helicobacter pylori (HP) and establishing the mathematical model for antibiotic selection based on the resistance data from 2009 to 2015 in 32 cities and counties in Zhejiang province. Methods The resistance rate of 534, 657 HP samples were analyzed from 58 hospitals in Zhejiang province from 2009 to 2015. The best combination of antibiotics by establishing 0-1 mathematical model, function calculation and roulette algorithm was obtained with city or county as a statistical unit. Results There were significant differences in clarithromycin and levofloxacin resistance rates among 32 cities and counties in Zhejiang province, with levofloxacin resistance significantly higher than that of clarithromycin. The mathematical model for antibiotic selection was established based on local antibiotic resistance data. Conclusion In the background of antibiotic resistance in China, the antibiotic resistance differences in different counties and populations in Zhejiang province can be a reference for HP eradication. Population-based antibiotic resistance detection and its potential of health economics is worth more attention. Key words: Helicobacter pylori; Drug tolerance; Small-area analysis; Sample size; Models, theoretical; Economics, medical

Willingness to have a second child among women with gynecological disease in China: a cross-sectional survey

BackgroundWith the end of 35 years of the one-child policy in China, the second-child policy presents a challenge for maternity hospitals. We aimed to inform configuration of medical resources by investigating willingness to have a second child in women with risk factors for adverse pregnancy outcomes. MethodsWe did a cross-sectional study in two hospitals in Zhejiang province, China. We surveyed women aged 30–45 years with gynecological disease (6000 in a university hospital and 6000 in a county hospital) by questionnaire, between January and April, 2016. The survey included questions about age, location, educational degree, occupation, physical health, family economic situation, current marital status, composition of women's parents' family, influence of second child on family and work, and childbearing history. Patients with malignant gynecological disease were excluded. Written informed consent was obtained, and the study was approved by the hospitals' institutional review boards. FindingsFor university hospital patients, willingness to have a second child was more closely associated with age (OR 1·005, 95% CI 0·105–3·843, p=0·005) and location (1·041, 0·077–10·37, p=0·043) than in county hospital patients. University hospital patients, with mean age 33·93 years (SD 3·77), were more likely to have two children than county hospital patients, with mean age 34·57 years (SD 4·20; OR 5·85, 95% CI 1·20–28·51, p=0·014). Patients living in rural areas were more likely to be willing to have two children than those living in cities (57·61%, 1060 of 1840 vs 45·91%, 1910 of 4160; OR 1·028, 95% CI 0·51–4·38, p=0·008). For county hospital patients, willingness to have a second child was more closely associated with parents' family composition (OR 1·082, 95% CI 0·02–7·05, p=0·05) than for university hospital patients. In the university hospital, women from families in which both husband and wife were only children, or in which the woman was an only child, were more likely to have two children than from families in which both husband and wife were not only children (64·57%, 1270 of 1966 vs 35·43%, 1670 of 4714, OR 1·02, 95% CI 0·04–10·22, p=0·017. InterpretationRisk factors for adverse pregnancy outcomes are not associated with a reduced willingness to have a second child. In addition to strengthening the capacity and quality of maternal health delivered by hospitals, the Chinese government should increase training and financial support for hospitals to cope with adverse pregnancy outcomes. FundingNone.

Practice and probes of mixed-ownership hospitals in Zhejiang province

Based on a field survey of typical hospitals in Zhejiang, this paper drew a conclusion on three models of the mixed-ownership hospitals development in Zhejiang.It summed up the experiences learnt in the practice about how to maintain the public welfare of the public hospitals, how to ensure the essential health services supply as well as the incentive mechanism for social capital.Suggestions were proposed to develop the mixed-ownership hospitals based on the analysis. Key words: Zhejiang province; Mixed-ownership; Public welfare; Social capital

Multiplication of blaOXA-23 is common in clinical Acinetobacter baumannii, but does not enhance carbapenem resistance.

To investigate the copy number of blaOXA-23 and its correlation with carbapenem resistance in carbapenem-resistant Acinetobacter baumannii (CRAB). A total of 113 blaOXA-23-positive clinical CRAB isolates were collected from two hospitals in Zhejiang province, China. Their genetic relatedness was determined by MLST. The MIC of imipenem was determined using the agar diffusion method and the copy number of blaOXA-23 was measured using quantitative real-time PCR (qRT-PCR). The complete genomes of five clinical CRAB strains were sequenced using PacBio technology to investigate the multiplication mechanism of blaOXA-23. Most of the isolates (100/113) belonged to global clone II and the MIC of imipenem ranged from 16 to 96 mg/L. The gene blaOXA-23 resided exclusively in Tn2006 or Tn2009. Approximately 38% of the isolates carried two or more copies of blaOXA-23. The copy number of blaOXA-23 was not correlated with the MIC of imipenem. Within the five sequenced strains, multiple copies of blaOXA-23 were either tandemly clustered or independently inserted at different genomic sites. Multiplication of blaOXA-23 is common in CRAB, but does not enhance carbapenem resistance. Multiplication can be present in the form of either tandem amplifications or independent insertions at different sites.

Validation of the Compassion Fatigue Short Scale among Chinese medical workers and firefighters: a cross-sectional study

ObjectivesTo examine the psychometric properties of the Chinese version of the C-Compassion Fatigue (CF)-Short Scale among 4 independent samples of Chinese emergency workers (medical workers and firefighters).DesignCross-sectional.Setting6 hospitals in Zhejiang...