China ; Hospitals, County ; Hospitals, Public

County-level hospitals, as medical and health centers in the counties, are mainly responsible for providing medical care for common and frequently-occurring diseases as well as rescuing acute critical patients. In 2018, editors of the Chinese Journal of Emergency Medicine evaluated the current situation of the emergency departments of county-level hospitals and found an unbalanced, inadequate, irregular, and unstable status existed among them. In order to provide developmental principles and constructional goals for the emergency departments of county-level hospitals, which located in different regions and with uneven foundations, Emergency Medical Branch of Chinese Medical Association particularly formulated this expert consensus. It not only suits for county-level general hospitals but also offers reference to the traditional Chinese medicine hospitals and specialized hospitals. The consensus includes: duties and scope of the emergency department, flow layout, equipment configuration and technology, job setting and staffing, management of emergency department, information construction and centralized construction. Construction specifications are divided into basic standards and recommended standards. The terms in the text are basic standards, and recommendations are improvements on basic standards. The basic standards are mainly suitable for the 2 Grade general hospitals, and the recommended standards mainly for 3 Grade general hospitals.
China ; Consensus ; Emergency Service, Hospital/organization & administration* ; Hospitals, County ; Humans

PURPOSE: Maintaining a sufficient and competent rural nursing workforce is an important goal of the Chinese health delivery system. However, few studies have investigated the health training status or conducted a needs assessment of rural Chinese nurses during this time of great transformations in health policy. This study was conducted to explore the current health training status of nurses working in rural Chinese township health centers (THCs) and to ascertain their perceived needs. METHODS: A cross-sectional survey using a self-administered structured questionnaire was conducted among 240 THC nurses in Guangxi Zhuang Autonomous Region, China from March 2014 to August 2014. The survey questionnaire was adapted from the Second Chinese Survey of Demographic Data and Training Demand for Health Professionals in THCs developed by the Ministry of Education. RESULTS: The nurses in THCs were young, with a low educational level. Their perceived needs for health training included further clinical studies at city-level hospitals to improve their skills and theoretical studies at medical universities in emergency medicine and general practice. Overall, 71.9% of the nurses with a secondary technical school background expected to pursue junior college studies, and 68.5% of the nurses with a junior college education expected to pursue a bachelor's degree. A decentralized program with theoretical studies at medical universities and practical studies at county hospitals was regarded as feasible by 66.9% of the respondents. CONCLUSION: Health-training programs for nurses in Chinese THCs must be improved in terms of coverage, delivery mode, and content. A decentralized degree-linked training program in which medical universities and city hospitals collaborate would be an appropriate mode of delivery.
Asian Continental Ancestry Group* ; China ; Cross-Sectional Studies ; Dronabinol ; Education ; Emergency Medicine ; General Practice ; Health Occupations ; Health Policy ; Hospitals, County ; Hospitals, Urban ; Humans ; Models, Theoretical ; Needs Assessment ; Rural Nursing ; Surveys and Questionnaires

BACKGROUNDThe self-consciousness and practicality of preferentially prescribed essential medicines (EMs) are not high enough in county hospitals. The purposes of this study were to use the information-motivation-behavioral skills (IMB) model to identify the predictors of essential medicines prescribing behavior (EMPB) among doctors and to examine the association between demographic variables, IMB, and EMPB.

METHODSA cross-sectional study was carried out to assess predictive relationships among demographic variables and IMB model variables using an anonymous questionnaire administered in nine county hospitals of Anhui province. A structural equation model was constructed for the IMB model to test the instruments using analysis of moment structures 17.0.

RESULTSA total of 732 participants completed the survey. The average age of the participants was 37.7 ± 8.9 years old (range: 22-67 years old). The correct rate of information was 90.64%. The average scores of the motivation and behavioral skills were 45.46 ± 7.34 (hundred mark system: 75.77) and 19.92 ± 3.44 (hundred mark system: 79.68), respectively. Approximately half (50.8%) of respondents reported that the proportion of EM prescription was below 60%. The final revised model indicated a good fit to the data (χ2 /df = 4.146, goodness of fit index = 0.948, comparative fit index = 0.938, root mean square error of approximation = 0.066). More work experience (β = 0.153, P < 0.001) and behavioral skills (β = 0.449, P < 0.001) predicted more EMPB. Higher income predicted less information (β = -0.197, P < 0.001) and motivation (β = -0.204, P < 0.001). Behavioral skills were positively predicted by information (β = 0.135, P < 0.001) and motivation (β = 0.742, P < 0.001).

CONCLUSIONThe present study predicted some factors of EMPB, and specified the relationships among the model variables. The utilization rate of EM was not high enough. Motivation and behavior skills were crucial factors affecting EMPB. The influence of demographic variables, such as income and work experience, on EMPB should be fully appreciated. Comprehensive intervention measures should be implemented from multiple perspectives.

Adult ; Aged ; China ; Cross-Sectional Studies ; Female ; Hospitals, County ; statistics & numerical data ; Humans ; Male ; Middle Aged ; Practice Patterns, Physicians' ; statistics & numerical data

OBJECTIVE: To construct prediction model for health workforce and hospital beds in county hospitals of Hunan by multiple linear regression. METHODS: We surveyed 16 counties in Hunan with stratified random sampling according to uniform questionnaires,and multiple linear regression analysis with 20 quotas selected by literature view was done. RESULTS: Independent variables in the multiple linear regression model on medical personnels in county hospitals included the counties' urban residents' income, crude death rate, medical beds, business occupancy, professional equipment value, the number of devices valued above 10 000 yuan, fixed assets, long-term debt, medical income, medical expenses, outpatient and emergency visits, hospital visits, actual available bed days, and utilization rate of hospital beds. Independent variables in the multiple linear regression model on county hospital beds included the the population of aged 65 and above in the counties, disposable income of urban residents, medical personnel of medical institutions in county area, business occupancy, the total value of professional equipment, fixed assets, long-term debt, medical income, medical expenses, outpatient and emergency visits, hospital visits, actual available bed days, utilization rate of hospital beds, and length of hospitalization. CONCLUSION The prediction model shows good explanatory and fitting, and may be used for short- and mid-term forecasting.
China ; Forecasting ; Hospital Bed Capacity ; Hospitals, County ; Humans ; Linear Models ; Models, Theoretical ; Workforce

OBJECTIVE: To analyze the main causes of medical dispute and the main types of medical malpractice. The related problems were discussed in forensic expertise. METHODS: Forty cases of medical dispute from 2006 to 2008 in our institute were analyzed retrospectively. RESULTS: In 40 cases of medical dispute, city-level hospitals, county-level hospitals, town-level hospitals and private clinics were 11 (27.5%), 24 (60.0%), 2 (5.0%) and 3 (7.5%) cases respectively. The internal medicine departments, surgical departments, gynaecological and obstetric departments, pediatric departments and outpatient center were 16 (40.0%),10 (25.0%), 9 (22.5%), 2 (5.0%) and 3 (7.5%) cases, respectively. The amount of cases from city-level hospitals, county-level hospitals diagnosed by the medical experts as the medical malpractice showed less than that from town-level hospitals and private clinics. CONCLUSION The amount of cases of medical dispute from city-level and county-level hospitals were more than that of town-level hospitals. But the amount of cases diagnosed by the medical experts as medical malpractice from city-level and county-level hospitals were less than that of town-level hospital and private clinics.
Expert Testimony ; Female ; Forensic Medicine ; Hospitals, County ; Hospitals, Urban ; Humans ; Male ; Malpractice/statistics & numerical data* ; Medical Errors/statistics & numerical data* ; Retrospective Studies

OBJECTIVES: This study was carried out to measure the urinary cotinine concentrations of Korean tobacco harvesters with green tobacco sickness (GTS). METHODS: We conducted a questionnaire survey and measured the urinary cotinine concentrations among the cases who visited six health subcenters and the emergency room in the Health Center and County Hospital after harvesting tobacco leaves in Cheongsong-gun, from Jul 15 to Aug 15, 2002. Ten suspected GTS cases were compared to 10 controls matched for residence, age, and sex. Urinary cotinine was analyzed with a reverse-phase high performance liquid chromatography (HPLC) system and expressed as geometric mean and standard deviation. The data collected were evaluated using the SPSS/win statistical package and the urinary cotinine concentrations between the two groups were analyzed by Mann-Whitney U test. RESULTS: In both the 10 cases and controls, there were 3 males and 7 females. Ages ranged from 22 to 70 years old. Half of the cases were reported within the 6 hours between 12:00 pm and 17:59 pm. The median time from starting work to initially feeling ill was 4.3 hours (min. 2.5; max. 11.0). The GTS symptoms reported were nausea in 10 cases (100.0%), dizziness in 9 (90.0%), weakness in 8 (80.0%), headache in 7 (70.0%) and other symptoms. The geometric mean of urinary cotinine concentrations was significantly higher (p<0.01) in cases at 497.6 +/- 2.5 ng/ml (min. 73.1; max. 2,574.3) than in controls at 32.7 +/- 1.8 ng/ml (min. 13.3; max. 76.9). CONCLUSIONS: Our study suggests that many tobacco harvesters may suffer from GTS in Korea. Therefore, it is very important for doctors to diagnose exactly the GTS. Also we must develop the methods which can prevent GTS, and simple methods of analysis for urinary cotinine.
Aged ; Chromatography, Liquid ; Cotinine* ; Dizziness ; Emergency Service, Hospital ; Female ; Headache ; Hospitals, County ; Humans ; Korea ; Male ; Nausea ; Nicotine ; Questionnaires ; Tobacco*

BACKGROUND: The relationship between type II diabetes and congnitive function has been explored in several studies. But the result was controversial. The purpose of the study was to determine whether diabetes mellitus in older patients(>or=65 years) is assiciated with cognitive dysfunction and to discover the related factors with th cognitive dysfunction. METHOD: Twenty patients with type 2 diabetes and twenty subjects with non-diabetes are studied with cognitive function test at Hwachun health center and county hospital. Cognitive function was assessed using Mini-Mental State Examination and Clock Drawing test and the score was analyzed. The diabetes groups were subdivided with duration of diabetes, HbAlc, chronic diabetic complications and then analyzed. RESULTS: A total of 6(30%) diabetic subjects scored below 24 on mini-mental state examination, compared with 3(15%) of controls(p=0.2560). The mean socres were 20.1+/-2.7 and 19.0+/-3.5 respectively. Clock drawing test demonstrated that 13(65%) diabetic subjects inconectly placed the numbers and hands, compared with 7(35%) of controls(p=0.0578>0.05). The duration of diabetes mellitus, HbAlc, chronic diabetic com- plications were not associated with cognitive dysfun- ction among diabetic subjects. CONCLUSIONS: The study showed that type 2 diabetes mellitus in the elderly is not associated with cognitive dysfunction, but further study should be done.
Aged ; Diabetes Complications ; Diabetes Mellitus* ; Diabetes Mellitus, Type 2 ; Hand ; Hospitals, County ; Humans

To try to determine the type of medical service wanted by the rural population, in Chungnam Province, a survey amongst the populations of 6 counties was conducted; Within the 6 counties, 2 local communities, which had no access to local medical services, were surveyed. The 12 communities were actively involved in Sae-Maul activities, and total number of households surveyed, was 822. The survey was conducted over a 1 month period, from July 16th, 1976, thru August 20th, and the followings are the results, summarized. 1. The largest number of respondents desired a combination of Public Health Center and Country Hospital, followed in order by Private Clinic and Modern Medical Facility. 2. The respondents, aged under 40 years, desired the Private Clinic type medical service, whilst those over 40 years of age, wanted the County Hospital, and as the numbers in this age bracket, were larger, so the ratio was much higher. 3. Sex, educational background, and occupation did not play any particular emphasis in the decisions. 4. Monthly income affected the responses to the survey. These in the lower-income bracket, wanted the County Hospital, and the ratio was high. These in the high income bracket desired the Modern Medical Service, accordingly. Those with an income of 50,000 won or less, amongst the low-income bracket, favored the Public Health sub-center type of service. The ratio for this service was very high.
Chungcheongnam-do ; Surveys and Questionnaires ; Family Characteristics ; Hospitals, County ; Occupations ; Public Health ; Rural Population