Hospitalized Patients In Department Research Articles

Analysis of Target Management of Average Hospitalization Days of Elderly Patients in Hospital Departments under the Background of DRG

Analysis of Target Management of Average Hospitalization Days of Elderly Patients in Hospital Departments under the Background of DRG

Evaluation of Thromboprophylaxis Practice in Hospitalized Patients in the Medical Department of Saint Jean de Dieu Hospital of Thies, Senegal

Introduction: Venous thromboembolism disease (VTE) is a common complication of hospitalization. Objective: To assess the practice of thromboprophylaxis in hospitalized patients in the department of medicine. Patients and Methods: It is an observational cross-sectional study conducted from 01 February to 31 March 2019 in the medical departments of the Saint Jean de Dieu Hospital of Thies. All the patients hospitalized with at least 18 years of age were included. The thromboembolic risk was assessed with the Padua score and thromboprophylaxis assessed according to the ACCP 2012 recommendations. Results: One hundred and forty four patients were included. Seventy-one (49.3%) were in the high thromboembolic risk category. The most frequently reported risk factors were mobility impairment (n = 72; 50%), age of 70 years or above (n = 35; 24.3%), heart failure (n = 23; 16%), acute infections (n = 14; 9.7%) and cancers (n = 13; 9.02%). The prevention of venous thromboembolism was practiced in 25 of the 71 patients with high thromboembolic risk or a rate of 35.2%. Thromboprophylaxis was exclusively drug-based with Enoxaparin. Conclusion: The practice of prophylaxis for VTE was low in the medical departments. Efforts still need to be made to reduce the high rate of thromboembolic complications associated with hospitalization.

Distribution and drug sensitivity of pathogenic bacteria in the rehabilitation ward

Objective To investigate the bacterial infection status, etiology distribution and drug resistance of neurological rehabilitation hospitalized patients, to guide the clinical rational use of drugs, to provide a scientific basis for the development of effective prevention and control measures. Methods From January 2011 to December 2014, the clinical data of 334 hospitalized patients in department of neurological rehabilitation of our hospital were retrospectively analyzed.The pathogenic culture results were analyzed. Results There were 334 strains of pathogenic bacteria, 83.53% of gram negative bacteria, 47 gram positive bacteria(14.07%), 8 fungi(2.39%).The top three infected gram negative bacterias were Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa.The main Gram positive bacteria was enterococcus.The detective gram negative bacterias were mainly sensitive to piperacillin penicillin/ tazobactam and cefoperazone/sulbactam and imipenem, meropenem, cefepime, amikacin.The resistance rate of Escherichia coli to gentamicin, piperacillin and levofloxacin was more than 50%.The resistance rate of Klebsiella pneumoniae to gentamicin and piperacillin was more than 50%. Conclusion The infection rate of urinary tract and respiratory tract is higher in patients with neurological rehabilitation ward, and the infection rate is higher, and the main part of gram negative bacilli, should be aimed at high risk patients and key links, strengthen the implementation of infection prevention and control measures, rational use of antimicrobial agents. Key words: Pathogen; Hospital units; Nervous; Epidemiologic methods

Application effects of continuous quality improvement on fall prevention of hospitalized patients in Department of Ophthalmology

Objective To explore the influencing of continuous quality improvement on fall prevention of hospitalized patients in Department of Ophthalmology. Methods It was established fall program team of continuous quality improvement, in order to focus specialty, bring into knowledge-attitude-behavior model so as to improve cognition of medical staff and patients, coordinate and cooperate, carry out predictive and targeted nursing according to evaluate, inform, prevent, rescue and improve safety management procedure. The fall incidence and nursing quality were compared in inpatients between before (2011 to 2012) and after (January 2013 to June 2014) continuous quality improvement. Results Before improvement, the fall incidence in inpatients was 0.27% (7/2 569) and dropped to 0 after improvement (χ2=6.50, P<0.05); after improvement, nurse educated rate and executed rate were 100% and 97.52%; patient′s awareness rate, executed rate and satisfaction rate were 91.98%, 90.01% and 98.49% better than those before improvement (χ2=224.67, 78.09, 58.37, 256.70, 135.56; P<0.01). Conclusions Nursing procedure is used to develop nursing quality continuous improvement, enhance safety awareness, improve cognition and behavior, so as to effectively prevent hospitalized patients to fall down in Department of Ophthalmology, enhance nursing quality, patient′s safety and satisfaction. Key words: Department of Ophthalmology; Hospitalized patients; Fall; Safety management; Continuous improvement of nursing quality

Application effect of nursing risk management on hospitalized patients in department of respiratory medicine

Objective To discuss the clinical effect of nursing risk management on hospitalized patients in department of respiratory medicine .Methods Nursing risk management was implemented from July 2012 in our department of respiratory medicine .A total of 64 patients before implementation were chosen as the control group, while 64 patients after implementation were chosen as the intervention group .Nursing quality and patients’ satisfaction were compared between two groups .Results After the implementation of nursing risk management, patients’ satisfaction on nursing increased from 87.5%to 96.9%, and there was no responsibility error or technical defect , and the differences were statistically significant （χ2 =3.12,4.15,5.27, respectively;P〈0.05）.The score of basic nursing quality and critically ill patients ’ nursing quality was respectively（94.5 ± 8.5）and （92.6 ±9.4）after nursing risk management, higher than （83.8 ±7.9）and（82.3 ±6.7）before, and the differences were statistically significant （t=3.62,3.24, respectively; P〈0.05）.Conclusions Nursing risk management in department of respiratory medicine can improve patients ’ satisfaction on nursing , reduce the occurrence of responsibility error and technical defect , as well as improve the professional level of nursing staff . Key words: Nursing management study; Department of respiratory medicine; Risk management; Effect

Three years surveillance of viral etiology of acute lower respiratory tract infection in children from 2007 to 2010

Viruses are common pathogens of acute lower respiratory tract infection (ALRTI) in children. There are few studies on consecutive monitoring of viral pathogens of ALRTI in a larger cohort during the past several years. The aim of this study was to investigate the viral pathogens of ALRTI in children of different age groups and to outline the epidemic feature of different viruses. (1) Totally 1914 (1281 male and 709 female) children with clinical diagnosis of ALRTI during the period of March 2007 to March 2010 were recruited into this study. These patients were hospitalized patients in department of internal medicine or outpatients in emergency department in Beijing Children's Hospital. The patients were divided into four groups, including 1072 patients < 1 year old, 326 patients 1- < 3 years old, 158 patients 3- < 6 years old, 358 patients ≥ 6 years old. One nasopharyngeal aspirate specimen was collected from each patient. Reverse transcription (RT) PCR methods were applied to detect common respiratory viruses including respiratory syncytial virus (RSV), human rhinovirus (HRV), influenza virus type A, B and C (IFA, IFB, IFC), parainfluenza virus (PIV) type 1-4, adenovirus (ADV), enterovirus (EV), human coronavirus (HCOV), human metapneumovirus (HMPV) and human bocavirus (HBOV). (1) The total positive rate of viruses was 70.3%. The positive rate was 83.0% (890/1072) in the group of < 1 year old, and 80.1% (261/326) in group of 1- < 3 years old, 60.8% (96/158) in group of 3- < 6 years old and 27.7% (99/358) in group of ≥ 6 years old, respectively. There was a significant difference in the positive rate among different age groups (χ² = 2213.5, P = 0.000). The top three viruses were RSV, HRV and PIV; and the positive rates were 50.9%, 36.2% and 12.0% respectively in group of < 1 year old. (2) The epidemic seasons of RSV and HRV were winter and spring, and PIV infection was epidemic in spring and summer. (3) The detection rates of 2 or more viruses were 38.2%, 36.4%, 30.2% and 15.2% in groups of < 1 year old, 1- < 3 years old, 3- < 6 years old and ≥ 6 years old, respectively. There was a significant difference in the mixed infection rate among different age groups (χ² = 1346.00, P = 0.000). RSV, HRV and PIV were the most predominant pathogens in younger children with ALRTI. Different viral infections had different seasonal features. Mixed infections with two or more viruses were detected in substantial proportion of patients with ALRTI, but further studies are needed to explore the clinical significance of mixed infection with viruses in patients with ALRTI.

Financing of therapeutic rehabilitation in the context of other non-invasive medical treatment specialties

Methods of financing health care services constantly undergo changes. These changes involve both the allocated financial resources and average prices received for person-day of treating patients in hospital departments of various specialties. Thus, a constant monitoring of financing levels and service pricing in particular types of health care services is indispensable, since these issues are directly associated with the development or stagnation observed in particular branches of medicine. This paper aimed at verifying the hypothesis that the pricing of person-day in the field of inpatient therapeutic rehabilitation, especially involving children, is under priced in relation to an average value of a person-day received in specialties providing non-invasive hospital treatment, and comparable as regards the costs of services. An analysis and comparison of costs and incomes for medical units providing health care services in selected areas of inpatient therapeutic rehabilitation for children and non-invasive hospital medical treatment have been attempted. This analysis has been carried out on the basis of data provided by the regional branches of the National Health Fund (NFZ). Generally available information concerning the terms and conditions of contracting services and agreements that NFZ has entered into with service providers has been also used. A comparison of the conditions for providing services that service providers should meet in order to obtain financing within the framework of NFZ, shows that personnel costs of a department of pulmonary rehabilitation and department of general rehabilitation are lower by approximately 15% than personnel costs of a department of pediatrics, and 9% lower than for a department of pediatric neurology. However, an average pricing of person-day received by rehabilitation departments is about 3-fold lower than that received by departments of pediatrics and pediatric neurology. Departments providing non-invasive medical treatment admit a large variety of patients. This diversification of patients only in part coincides with patients admitted to rehabilitation departments. Thus, additionally average pricings of person-day at departments providing non-invasive medical treatment and departments of general rehabilitation with respect to selected diagnosis related groups of patients who manifest diseases treated in both types of departments, have been compared. The obtained results have confirmed gross under financing of inpatient rehabilitative services. Inpatient rehabilitative services offered for children are particularly undervalued. In this instance, service providers bear higher costs, resulting from, among other considerations, a larger average number of physiotherapists necessary to conduct rehabilitation, the requirement of assuming the full legal responsibility for children which necessitates additional educational care and 24-hours medical care, not only in the case of neurological rehabilitation, as well as providing nutrition adequate for children's ages, including five high-quality meals daily. Consequently, it is necessary to increase the pricing of inpatient rehabilitative services provided for children.

Relationship between HIV-1 viral load and continued drug use in untreated infected injection drug users

The role of continued drug use in development of AIDS has been investigated, using mainly CD4(+) cells as outcome variable. The objective of this study was to verify whether continued drug use can influence HIV-1 plasma viral load.We used cross-sectional enrolment data of the HIV-infected IDUs cohort study Manif 2000 (October 1995-October 1996), recruiting patients in hospital departments of Marseilles, Nice and Paris suburbs. To minimize biases due to differential access to health care, only patients receiving outpatient care for at least 2 years but with no antiretroviral treatment were selected for analysis (n = 108). Available information regarding clinical and laboratory information from medical records and clinical examination as well as drug use and HIV-related risk practices were obtained by a face-to-face and a self-administered questionnaire. Patients denying recent heroin injection were cross-validated by a serological assay to detect morphine. Forty-two patients (39%) reported recent heroin injection; among those denying recent use (n=66), eight (positive for serum morphine assay) were re-classified as IDUs. A difference of 0.35 log in viral load was observed between active and ex-IDUs which increases (0.6 log, p=0.03) in those who have been using drugs for 10 years or more.This result persisted when adjusted for CD4(+) counts, clinical stage or years since diagnosis. Continued drug use may have a significant but limited impact on HIV viral load only in patients with a longer history of drug use. Consequences of persisting drug use on long-term progression to AIDS has to be investigated further.

Industrial units in psychiatric hospitals.

The recent development of industrial therapy (Early 1960 and 1963; Wadsworth 1958, 1961, 1962 and Smith 1963) in British mental hospitals reflects our current therapeutic optimism and takes advantage of a period of full employment in industry. Industrial therapy has been found to be an important weapon in the prevention or cure of institutional neurosis (Barton 1959). It is, of course, well known that during the past two decades institutional neurosis has been markedly reduced by a more permissive and non-authoritarian approach to patients, including amongst other things greater freedom, more enlightened nursing and the use of group techniques and occupational therapy in various forms. However, if patients are to be rehabilitated and the best use made of their personality resources, their lives within the hospital should be as close as possible to normal life in the community, and it follows that like normal citizens they should be employed at productive, useful and satisfying work for which they should receive proper economic rewards. This work may be in a factory setting, but need not exclude in some circumstances work in certain hospital departments. However, in order to prevent confusion the term industrial therapy should only be used when “patients are employed in factory-type work under medical and nursing supervision which aims at their rehabilitation and/or resettlement, the nature of the work being related to the needs of the individual patient, giving him both psychological and economic satisfaction”. It appears that in the United States the traditional employment of patients in hospital departments without pay (except token payments in kind) is now being called industrial therapy; it is likely, however that American interest in the totally different British concept of industrial therapy will lead there to a change in approach. It should, therefore, be stressed that an integral part of industrial therapy is financial reward for work done according to ability, motivation and production. Thus “economic satisfaction” is an essential part of any definition.