ObjectiveBased on the off-label drug use (OLDU) record application of alprostadil injection (Lipo-PGE1) which was the only one rejected in the Guangdong General Hospital in 2013, we retrospectively investigated all the background information of inpatients' OLDU of Lipo-PGE1 in 2012, so as to provide references for intervention of OLDU and effect evaluation. MethodsAccording to OLDU in dose record application of clinical departments, we summarized medical orders about inpatients' use of Lipo-PGE1 during hospitalization in 2012 and analyzed OLDU situation according to drug labels. Then, we summarized situation of drug use in all departments, analyzed OLDU incidence in dose, calculated prescribed daily dose (PDD) and drug use density (DUD) in each department to evaluate the degree of OLDU in dose. Resultsa) A total of 106 576 medical orders involving 8 620 case-times were analyzed. According to the data of cases, medical orders and drug use amount, the OLDU incidences were 34.43%, 25.16% and 41.37%, respectively. Lipo-PGE1 was used in every clinical department in this hospital and OLDU occurred in 69.44% departments (25/36). b) According to the number of medical orders, there were 6 departments with the OLDU incidence in dose > 50% and 5 departments with the OLDU incidence in dose during 50% to 20%. c) The average of PDD of the whole hospital was 12.77 μg. A total of 25 departments' PDDs were off-label, and 10 departments' PDDs were above the average level of the whole hospital. The ICU's PDD was the highest, with 2.35 times more than label dose. d) The PDD in each department was not directly proportional to DUD, which indicated the degree of OLDU in dose was not directly proportional to use intensity. This may be caused by different disease burdens in departments. ConclusionLipo-PGE1 is widely used in the Guangdong General Hospital where OLDU in dose occurs commonly. Since PDD and DUD reflect different contents, the two indicators should be combined to monitor OLDU.
Objective To investigate the application of risk assessment in the control of nosocomial infections in surgical departments of infectious disease hospitals so as to provide references for the regulation of prevention and control measures. Methods Nosocomial infection risks in surgical departments of infectious disease hospitals were identified by the method of brainstorming. Based on risk assessment and planning of American children's national medical center in Washington for epidemic and infectious diseases control, the matrix method was used for risk assessment. The three highest risks were controlled, and then we compared the incidence of nosocomial infections before and after the risk assessment. Results The major risk factors in surgical departments existed in the process of diagnosis and treatment. By matrix scoring, excluding high readiness items, we found that the top three risks were airborne diseases, prevention and nursing of hematogenous infections and air disinfection. Nosocomial infection rate in the surgical departments dropped to 2.03% after carrying out risk assessment and taking correspondent measures (χ2=5.480,P=0.019). Conclusion Evaluation of nosocomial infection risk in surgical departments of infectious disease hospitals can discover major potential risks and reduce the incidence of nosocomial infections, which can provide references for management and control of nosocomial infections.
Objective To investigate a suspected outbreak of hospital-acquired infections caused by Mycobacterium chelonae related to flexible bronchoscope (hereinafter referred to as “bronchofibroscope”) and apply targeted high-throughput sequencing (tNGS) technology for etiological analysis, providing references for controlling hospital infection outbreaks. Methods A retrospective survey of patients who were detected with Mycobacterium chelonae through tNGS testing of bronchoalveolar lavage fluid (BALF) after bronchofibroscopy at the Zhengdong District, People’s Hospital of Henan University of Chinese Medicine, People’s Hospital of Zhengzhou between May 1, 2018 and March 18, 2024. The causes were investigated through comprehensive measures including on-site epidemiological surveys and environmental health assessments, and intervention measures were developed and evaluated for effectiveness. Results A total of 52 patients were included. Mycobacterium chelonae was detected in 30 patients, nosocomial infection was excluded in all cases. The suspicious contaminated bronchofibroscope lavage fluid and its cleaning and disinfection equipment, environment and other samples were collected. The traditional microbial culture results were negative. The tNGS results showed that Mycobacterium chelonae was detected in bronchofibroscope lavage fluid (sequence number 156), and all the patients with Mycobacterium chelonae detected in BALF used the bronchofibroscope. It was judged that this event was a pseudo-outbreak of nosocomial infection caused by the contamination of bronchofibroscope with the patient’s BALF. After three months of continuous follow-up after the comprehensive control measures were taken, Mycobacterium chelonae was not detected by tNGS in bronchofibroscope lavage fluid or patients’ BALF. All patients in the hospital improved and discharged without any new cases. The pseudo-outbreak of nosocomial infection was effectively controlled. Conclusions There are many links in the reprocessing of bronchofibroscope, which is easy to cause pollution, and the management needs to be strengthened. tNGS detection has the characteristics of high efficiency, few background bacteria and clear pathogen spectrum, which can be used as a supplementary means for the investigation of nosocomial infection outbreaks, and is of great significance for identifying the source of infection and determining the transmission route.
Objective To explore the influencing factors of the usage behavior of the scientific research management system and provide references for hospitals in constructing scientific research management systems. Methods Data were collected through questionnaires in April 2024. Based on the unified theory of acceptance and use of technology (UTAUT), the information system success model, and the self-efficacy theory, a research model on the influencing factors of the usage behavior of the scientific research management system among medical staff was constructed from the dual perspectives of users and information systems. The structural equation model was utilized to explore the influencing factors of the usage behavior of the scientific research management system. Results A total of 527 questionnaires were collected. Among them, there were 157 males and 370 females. The overall Cronbach α coefficient of the questionnaire was 0.916, and the KMO value was 0.896. For Bartlett’s test of sphericity (P<0.001). The composite reliability of each latent variable was greater than 0.7, and the average variance extracted was greater than 0.5. Therefore, this questionnaire had good reliability and validity. The research showed that information quality, performance expectancy, effort expectancy, and system quality all had significant positive impacts on the usage intention of users of the scientific research management system (P<0.05). Meanwhile, facilitating conditions and usage intention both had significant positive impacts on the usage behavior of users (P<0.05). Conclusions The construction of the scientific research management system should be guided by management needs, comprehensively sort out the general scientific research work needs of medical staff. Through the apply information-based means, various forms of training, and strengthening policy guidance, the aim is to improve the intelligence level of system operations, enhance the convenience of user self-service, and promote the effective construction of the ecosystem of the scientific research management system.
摘要:目的: 探讨传染病医院工作人员对甲型H1N1流感医院感染控制知识的认知程度。 方法 :选择救治甲型H1N1流感期间传染病医院不同岗位工作人员进行无记名自填式调查问卷。 结果 :全院对甲型H1N1流感医院感染控制认知总体情况良好,认知的薄弱环节是对防护措施,尤其是一级防护和三级防护的认知;不同工作岗位的工作人员对甲型H1N1流感医院感染控制认知程度不同,与甲型H1N1流感有接触的工作人员认知度高于其他工作人员,中高级职称、高年龄段(35岁以上)的医务人员认知度高于初级职称及低年龄段(35岁以下)的医务人员。 结论 :针对薄弱环节,进一步加强全员医院感染控制知识、技能的培训考核。Abstract: Objective: To explore the knowledge about the Influenza A (H1N1) of Chengdu Hospital for Infectious Diseases ‘s staff. Methods : Different medical staff of the infectious Disease Hospital during the influenza A (H1N1) treatment in Chinese mainland was selected to fill in anonymous questionnaire. Results : The awareness of the hospital is well about the hospital infection control to Influenza A (H1N1). Preventive measure is weak, especially about the primary barriers and the third barriers. The different position awareness is different. The staff who is in touch with Influenza A (H1N1) is more awareness than the others, the senior and intermediate title is more awareness than the Junior Title, the high ages group(over 35 ages) is more awareness than the low ages group (under 35 ages). Conclusion : For the weak link, further strengthens the entire hospital infection control knowledge, skills training and examination.
Objective To investigate the effectiveness of teaching morning handover in clinical teaching of traditional Chinese medicine (TCM) in general hospitals. Methods A retrospective study was conducted at the Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University from April 2023 to March 2024, involving a total of 220 participants including interns, postgraduates/standardized training students, and residents/refresher students. The control group consisted of trainees who studied from April to September 2023, while the observation group included those who studied from October 2023 to March 2024. Teaching morning handover was added to the clinical morning report for the observation group, while the control group only conducted the conventional clinical morning report. Due to the differences in basic knowledge and clinical positioning, trainees except interns were classified as clinical residents. A questionnaire survey including satisfaction of teaching content, teaching methods, teaching ability and teaching management and graduation assessment including total score, theoretical assessment score, clinical process score and participation in teaching activities were compared between the two groups. Results Compared with those of the interns (n=57) and clinical residents (n=49) in the control group respectively, there was no statistically significant difference in satisfaction of teaching content, teaching methods or teaching ability of the interns (n=78) and clinical residents (n=36) in the observation group (P>0.05); however, teaching management satisfaction was significantly improved (interns P=0.002, clinical residents P=0.022). Both the interns and clinical residents in the observation group had a significantly higher total score as well as theoretical assessment score and increased participation in teaching activities (P values for interns were <0.001, 0.001, and <0.001, respectively, and for clinical residents were <0.001, 0.013, and <0.001, respectively). However, there was no significant difference observed between groups regarding clinical process score (P>0.05). Conclusion Teaching morning handover is helpful in improving the quality of TCM teaching in general hospitals and is an effective model for clinical teaching of TCM.