Enhanced recovery after surgery (ERAS) has been widely used in the world for near 20 years, which should be considered as the milestone of modern medicine advancement, changing the routine perioperative principle, accelerating the recovery speed following operation, minimizing the postoperative pain, and saving the medical resources. Despite the remarkable advance, the quality and application of ERAS in the west China needs further improvement if compared with international level or even some domestic hospitals. The postoperative hospital stay in west China is much longer than the reported 3 to 5 days according to published references. Several suggestions can be help: (1) Based on the published consensus and the successful experiences of ERAS in colorectal surgery, the medical institution should make great effort to extend this technique to change the profound traditional idea in medical staffs and patients. (2) The medical administrations should take the application of ERAS as a key performance index and annual work plan in hospital. (3) Multiple disciplinary team including anesthetist, surgeon, dietitian, and nurses is essential for hospital to promote the quality of ERAS. Undoubtedly, ERAS is going to be the conventional medical care in the western area of China. We may look forward to seeing more researches from western China to update the ERAS consensus.
China ; Clinical Competence ; Colorectal Surgery ; rehabilitation ; Consensus ; Digestive System Surgical Procedures ; rehabilitation ; Health Knowledge, Attitudes, Practice ; Humans ; Length of Stay ; statistics & numerical data ; Patient Care Team ; standards ; trends ; utilization ; Personnel Administration, Hospital ; methods ; Postoperative Care ; methods ; psychology ; standards ; Postoperative Period ; Quality of Health Care ; standards ; trends

After-Hours Care ; Attitude of Health Personnel ; Attitude to Health ; Child ; Cross-Sectional Studies ; Emergency Service, Hospital ; utilization ; Humans ; Medical Overuse ; Parents ; Pediatrics ; Primary Health Care ; Singapore ; Surveys and Questionnaires

The development of information technologies has led to the era of big data; such enormous collections of information on drugs and adverse drug reactions are stored in either a structured, a semistructured, or an unstructured form. Because of the nature of the emerging issue of drug safety, it is common for policy makers and healthcare professionals to make decisions without sufficient evidence. Big data may be used as an efficient pharmacovigilance tool, which enables us to recognize adverse drug reactions that may not have been identified in pre-marketing clinical trials, in order to capture the patterns of drug utilization and adverse events, and to predict the occurrence of adverse drug reactions. National surveillance systems using electronic health databases have been established successfully in the US and Europe. The Korea Institute of Drug Safety and Risk Management (KIDS) plans to establish a big data platform for pharmacovigilance in Korea. The big data may be effectively used for evidence-based regulatory and clinical decision making in the field of drug safety and risk management.
Administrative Personnel ; Decision Making* ; Delivery of Health Care ; Drug Utilization ; Drug-Related Side Effects and Adverse Reactions ; Europe ; Humans ; Korea ; Pharmacoepidemiology ; Pharmacovigilance ; Risk Management

PURPOSE: The present survey was conducted to investigate the perceptions among nurses of neonatal pain and the associated use of pharmacologic measures (PMs) and nonpharmacologic comfort measures (CMs) in neonatal intensive care units (NICUs). Pain perception, the necessity and actual use of PMs and CMs, and their relationships were investigated and compared according to nurses' positions, educational levels, the existence of guidelines, and prior education on neonatal pain management. METHODS: Participants were 141 nurses from five NICUs at university hospitals. A questionnaire was developed by researchers based on previous studies of neonatal pain management and current practices in surveyed NICUs. Five-point Likert scales were used to assess nurses' perceptions of pain, the necessity of PMs and CMs, and their actual use in 29 painful procedures. RESULTS: The mean scores of perceived pain and the necessity of PMs and CMs were 3.68, 2.96, and 3.79 points, respectively. The actual use of PMs and CMs was 1.67 and 2.63 points, respectively. The perceived necessity of PMs correlated with the actual use of PMs (r = .316, p < .001), and CMs were performed (r = .390, p < .001). Keeping or reading guidelines, or receiving education on pain management resulted in a higher perception of the necessity of PMs. CONCLUSION: Korean nurses in NICUs often underestimate the necessity of pain relief measures and use few PMs or CMs. Therefore, systematic approaches to implement guidelines, such as adaptation of guidelines for each NICU, dissemination of guideline content to all NICU staff, and regular measurements of compliance with the guidelines, are recommended.
Adult ; *Attitude of Health Personnel ; Cross-Sectional Studies ; Female ; Humans ; Infant, Newborn ; *Intensive Care Units, Neonatal ; Intensive Care, Neonatal/*methods ; Nursing Staff, Hospital/*psychology ; Pain/nursing ; Pain Management/*methods/psychology/*utilization ; Questionnaires ; Republic of Korea ; Young Adult

BACKGROUNDChanging health care providers frequently breaks the continuity of care, which is associated with many health care problems. The purpose of this study was to examine the association between a change of health care providers and pregnancy exposure to FDA category C, D and X drugs.

METHODSA 50% random sample of women who gave a birth in Saskatchewan between January 1, 1997 and December 31, 2000 were chosen for this study. The association between the number of changes in health care providers and with pregnancy exposure to category C, D, and X drugs for those women with and without chronic diseases were evaluated using multiple logistical regression, with adjusted odds ratios (ORs) and its 95% confidence intervals (CIs) as the association measures.

RESULTSA total of 18 568 women were included in this study. Rates of FDA C, D, and X drug uses were 14.35%, 17.07%, 21.72%, and 31.14%, in women with no change of provider, 1-2 changes, 3-5 changes, and more than 5 changes of health care providers. An association between the number of changes of health care providers and pregnancy exposure to FDA C, D, and X drugs existed in women without chronic diseases but not in women with chronic disease.

CONCLUSIONChange of health care providers is associated with pregnancy exposure to FDA category C, D and X drugs in women without chronic diseases.

Adult ; Continuity of Patient Care ; Databases, Factual ; Drug Prescriptions ; statistics & numerical data ; Drug Utilization ; statistics & numerical data ; Female ; Health Personnel ; Humans ; Logistic Models ; Pharmaceutical Preparations ; Pregnancy ; drug effects ; Saskatchewan ; United States ; United States Food and Drug Administration

OBJECTIVETo conduct a study on attitudes, knowledge, and use of complementary and alternative medicine (CAM) therapies in Serbia. Available data about CAM therapies in the region are scarce, opinions lacking from health sector. Balkan region countries had a delay in issuing national policies on CAM therapies.

METHODSThe questionnaire used was based on previously validated CAM Health Belief Questionnaire (CHBQ), formulated as 5-item Likert type scale, adjusted for local environment. Health care students and professionals were evaluated. The questionnaire comprehended 10 closed questions on attitudes, knowledge and use of CAM therapies. This survey was conducted in eight cities of Serbia, January 2010-July 2011. A total of 797 participants was included. The second group of participants was 145 healthcare professionals (50 academic staff, 64 clinical staff, 19 pharmacists, 6 other clinical branch specialists and 6 nurses). Data were collected by an interview. Examinees could acquire maximum of 70 points, 35 representing neutral attitude.

RESULTSStudents of dentistry (54.65±6.07) were better informed on CAM therapies than medicine students (50.26±7.92). Pharmacy students (51.16±7.10) accepted low-scientific CAM. Pharmacists scored better than university professors (55.12±6.55 vs. 50.29±9.50). Primary health care professionals had better awareness than pharmacists in dispensing pharmacies. Both groups of participants preferred use of vitamins over any other CAM therapy.

CONCLUSIONThese pioneering efforts in the region exposed weaknesses in CAM attitudes of current and future health care professionals. Nevertheless, awareness on alternative medicine treatment choices is growing among Balkan prescribers. Supportive legal framework would facilitate dissemination of CAM medical practices.

Attitude of Health Personnel ; Complementary Therapies ; utilization ; Cross-Sectional Studies ; Delivery of Health Care ; statistics & numerical data ; Health Knowledge, Attitudes, Practice ; Health Personnel ; Humans ; Serbia ; Students ; Surveys and Questionnaires

PURPOSE: The purpose of this study was to evaluate a self-care program for elders with osteoarthritis managed by primary health care workers, Community Health Practitioners (CHPs), in rural Korea. METHODS: The self-care program, consisting of 7 areas, was evaluated with a randomized experimental study for patients over age 60 with osteoarthritis in which 150 participants in the experimental group and 140 in the control group were compared. The self-care program was implemented for six weeks, 2 hours per week, at community health posts by CHPs. Data were collected using an interview questionnaire given by the CHPs and laboratory tests before and after the intervention for both groups. Propensity score matching analysis was done to test effectiveness after controlling for confounding variables. RESULTS: The intervention group showed a significant decrease in the number of painful joints (p<.001) and a significant increase in self-care ability (p<.05) compared to the control group. CONCLUSION: Study results indicate that training and utilizing primary health care workers in rural areas is valuable in increasing the generalization and continuity of intervention programs. As arthritis should be managed life-long, CHP directed self-care programs are useful interventions for rural elders with arthritis to learn self-care management.
Aged ; *Aged, 80 and over ; Asian Continental Ancestry Group ; Community Health Services ; Female ; Health Personnel/*utilization ; Humans ; Interviews as Topic ; Male ; Middle Aged ; Osteoarthritis/*prevention & control ; Pain Management ; Program Evaluation ; Propensity Score ; Questionnaires ; Republic of Korea ; Rural Population ; *Self Care

INTRODUCTIONVaccination against the 2009 pandemic influenza A (H1N1) represents the best method of controlling spread, morbidity and mortality due to the pandemic. While this has been recommended for all healthcare-workers locally, it is unclear if they are willing to accept the vaccination.

MATERIALS AND METHODSA cross-sectional survey was conducted before and after an educational talk on pandemic influenza and vaccines to ascertain responses and stated reasons, as well as identify associated factors.

RESULTSFor 235 returned forms prior to the talk, 182 (77.4%) responded positively, while 161 of 192 (83.8%) who returned forms after the talk responded positively. Importantly, 12 of 47 (25.5%) initially negative responses turned positive after education. The desire to protect family, self and patients were the 3 most important reasons for staff wanting to receive the vaccine, while the concern regarding potential side effects was the most important reason for refusal.

CONCLUSIONSA high rate of willingness to receive pandemic influenza vaccine was found, which was in contrast to acceptance rates elsewhere and during previous influenza seasons. Education can play an important role in altering vaccine acceptance behaviour, with an emphasis on addressing concerns with regard to potential side effects.

Adult ; Aged ; Attitude of Health Personnel ; Cross-Sectional Studies ; Female ; Health Education ; Health Knowledge, Attitudes, Practice ; Humans ; Immunization Programs ; utilization ; Influenza A Virus, H1N1 Subtype ; drug effects ; immunology ; Influenza Vaccines ; Influenza, Human ; drug therapy ; virology ; Male ; Middle Aged ; Patient Acceptance of Health Care ; Program Evaluation ; Young Adult

OBJECTIVES: To explore the information sources and knowledge on infant vaccinations of pro-vaccination community members and anti- accination community members on the internet. METHODS: An online survey of 245 parents from three pro-vaccination communities and 92 parents from one antivaccination community was conducted from June 7 to June 23, 2006. RESULTS: Parents from pro-vaccination communities usually gained the information regarding vaccination efficacy and risk mainly from healthcare providers (49.8%) and mass media (47.7%). Pro-vaccination community members considered healthcare providers as the most credible sources of information on vaccination, whereas the anti-vaccination community members usually gained their information regarding vaccine efficiency and risk from Internet child-care cafes and online vaccination communities. Parents of the anti-vaccination community considered the internet as the most credible information source (77.6% for efficacy, 94.8% for risk). In addition, the major reason why anti-vaccination community members didn't vaccinate and, will not vaccinate, was concern about possible side effects of the vaccine. The knowledge level on infant vaccination, education and economic status was higher in the anti-vaccination community. CONCLUSIONS: On-line communities concerned with vaccination are getting popular. The influence of antivaccination parents on the Internet is expected to be high. The government and healthcare providers need to increase their efforts to improve the credibility of information about vaccination. Our findings suggest that online communication regarding vaccinations needs to be considered as a means to increase vaccination rates.
Adult ; Child, Preschool ; Female ; Health Education/*methods ; *Health Knowledge, Attitudes, Practice ; Health Personnel ; Humans ; Infant ; Internet/*utilization ; Male ; Parents ; Socioeconomic Factors ; *Vaccination

INTRODUCTIONAs preparation against a possible avian flu pandemic, international and local health authorities have recommended seasonal influenza vaccination for all healthcare workers at geographical risk. This strategy not only reduces "background noise", but also chance of genetic shifts in avian influenza viruses when co-infection occurs. We evaluate the response of healthcare workers, stratified by professional groups, to a non-compulsory annual vaccination call, and make international comparisons with countries not at geographical risk.

MATERIALS AND METHODSA cross-sectional study was performed over the window period for vaccination for the 2004 to 2005 influenza season (northern hemisphere winter). The study population included all adult healthcare workers (aged < or =21 years) employed by a large acute care tertiary hospital.

RESULTSThe uptake rates among frontline caregivers--doctors >50%, nurses >65% and ancillary staff >70%--markedly exceeded many of our international counterparts results.

CONCLUSIONGiven its close proximity in time and space to the avian flu pandemic threat, Singapore healthcare workers responded seriously and positively to calls for preventive measures. Other factors, such as the removal of financial, physical and mental barriers, may have played important facilitative roles as well.

Adult ; Animals ; Attitude of Health Personnel ; Birds ; Cross-Sectional Studies ; Disaster Planning ; organization & administration ; Female ; Humans ; Influenza A Virus, H5N1 Subtype ; Influenza Vaccines ; therapeutic use ; Influenza in Birds ; Influenza, Human ; prevention & control ; Male ; Personnel, Hospital ; psychology ; statistics & numerical data ; Seasons ; Singapore ; Vaccination ; utilization