Retrospective analysis of cataract surgery outcomes in China from 2009 to 2018: from a national registry system data.

OBJECTIVE: To evaluate patients' benefits after cataract surgery and to form recommendations for Chinese national health policy decision makers and administration departments based on the quality of cataract treatments. METHOD: An observational study based on real-world data source from the National Cataract Recovery Surgery Information Registration and Reporting System. RESULTS: A total of 14 157 463 original records were reported from 1 July 2009 to 31 December 2018. The factors that influenced the 3-day postsurgical best-corrected visual acuity (BCVA), the primary outcome, were analysed by logistic regression analysis. We found that a history of hypertension (OR=0.916) or diabetes (OR=0.912), presurgical pupil abnormality (OR=0.571) and high intraocular pressure (OR=0.578) were harmful to the postsurgical BCVA improvement (BCVA ≥6/20), while male sex (OR=1.113), better presurgical BCVA level (OR=5.996 for ≥6/12-<6/7.5 and OR=2.610 for >6/60-<6/12 taken ≤6/60 as reference), age-related cataract (OR=1.825) and intraocular lens implantation (OR=1.886) were statistically beneficial to the postsurgical BCVA improvement. Compared with extracapsular cataract extraction (ECCE) with large incision, the ECCE with small incision (OR value=1.810) and the phacoemulsification (OR=1.420) significantly improved the benefit probability. CONCLUSION: ECCE with small incision has comparable effects on postsurgical BCVA improvement of phacoemulsification. Therefore, ECCE could be an alternative cataract surgical treatment in economically underdeveloped areas in China, provided the surgeons are adequately trained.

Nurse staffing in large general hospitals in China: an observational study.

BACKGROUND: The appropriate staffing of nurses not only reflects the situation of nursing management of human resource, but also is related to the nursing quality in hospitals. This study investigated the staffing of nurses in large general hospitals in China. METHODS: In this study, a database established by the National Centre for Nursing Care Quality Control, which conducted a national survey of the staffing of nurses in China mainland in 2017, was analysed. The time-point survey data of 20 375 departments in 668 large general hospitals in China were obtained, including the information of nurses and patients during the day (10:00 am) and at night (10:00 pm). Then, the staffing of nurses was evaluated by calculating the nurse to patient ratio (the average number of patients assigned to a nurse, NTP ratio). The Kruskal-Wallis test was performed to compare the NTP ratios during the day and at night among different regions and departments. RESULTS: In large general hospitals, a nurse takes care of eight patients (NTP ratio = 1:8.0) during the day and 23 patients at night (NTP ratio = 1:23) on average. There were significant differences between day and night. In terms of different regions, a nurse in the hospitals in the western region takes care of 7.8 patients during the day (NTP ratio = 1:7.8) on average, and the nursing resource in the western region is more adequate than that in the eastern (1:8.0) and central (1:8.0) regions. At night, the eastern region has a higher level of NTP (1:23.0). In terms of departments, a nurse working in the ICU takes care of two patients during the day (NTP ratio = 1:2.0) and 2.9 patients at night (NTP ratio = 1:2.9). The level of NTP in the oncology department is relatively higher: 9.3 during the day and 34.0 at night. Other departments including internal medicine, surgery, obstetrics and gynaecology, paediatrics, and geriatrics have NTP ratios of 1:7-8 during the day and 1:18-25 at night. CONCLUSIONS: In China, the nurse staffing of large general hospitals has some regional and departmental patterns. The low level of nurse staffing at night may be a problem worthy of attention; the Chinese government needs to establish standards for different periods and departments to improve efficiency and quality of nursing.