公立医院改制的动力、特点与相关政策

该文根据现场调查,对公立医院转制为民办非营利性医院或民办营利性医院的动力和阻力进行了角色分析,揭示了目前公立医院转制的特点和问题,并对公立医院的改制提出了政策建议:建立公立医院转制的原则和程序,制定医院资产评估和拍卖的管理办法,转化医院职工的身份,减少改革成本.     

公立医院产权制度改革实践的思考△

该文探讨了公立医院产权制度改革的效用和存在问题,并提出应对策略,认为产权制度的改革虽然不是解决公立医院发展问题的决定性因素,但是可以在特定的时机和条件下,以外力改变医院的发展困境,起到杠杆的作用。因此要认识改革的一般性和特殊性,坚持分类改革的原则,明确公立医院改制的主要方向,注重投资人和管理者的遴选机制、院长的考核与激励机制、以及医院文化建设,多方合力推动改制医院走向良性运行的轨道,更好发挥其社会效益。     

取消药品加成对公立医院运行模式的影响

公立医院药品加成政策出台至今已经有55年的历史,是现行医院的经济补偿政策。2008年新医改方案提出,探索建立比较规范的公立医院管理体制和运行机制,采取有效方式改革以药补医机制。目前如何改变医院原有的经济运行模式以适应新的形势已成为解决问题的关键。文章将通过对我国药品加成的历史沿革及其对公立医院产生的影响的分析,探讨取消这一政策后医院面临的问题和困境,提出相应的对策建议。     

基于利益相关者理论视角分析我国实行公立医院法人治理结构的可行性

随着我国公立医院改革的日渐深入,探索建立医院法人治理结构被提上议事日程。文章基于利益相关者理论,对我国实行公立医院法人治理结构的动力和阻力进行深入分析,并有针对性地提出政策建议,以消除相关利益者的阻力,加速公立医院改革进程。     

结合公立医院改革探索传染病医院发展之路

公立医院改革是传染病医院制定新的发展策略的外部条件。如何借助改革契机解决发展所面临的困境是传染病医院在公立医院改革中需要解决的核心问题。抓住机遇,剖析现状,通过探索科学合理的发展策略,实现传染病医院发展的既定目标。     

公立医院改革的困境及改革中政府的职责

分析公立医院改革的困境,提出产权改革是公立医院管理体制改革的核心和基础,并指出政府在改革中的职责.     

公立医院改革的组织系统变革阻力调查与对策探讨

[目的]了解公立医院的组织管理体制、制约公立医院发展的主要因素等,运用现代管理学的理论和方法,初步阐明公立医院在改革发展中所存在的组织系统变革问题,为广州市公立医院的改革和发展提供借鉴.[方法]围绕医护人员日常工作态度的方式和对医院管理工作的认识,设计医护人员调查问卷,立足于广州公立医院展开调查.[结论]广州市公立医院的组织变革初显成效,医疗服务内容较为广泛且有良好的医疗服务质量,但仍然普遍存在着医院组织系统方面的阻力,如医院信息沟通障碍,医院组织创新文化有待完善等.[建议]为促进公立医院改革和发展,须建立良好的流通渠道、进一步创新企业文化、保持并加强富有结构弹性的组织系统建设.     

公立医院产权改革必须大力推进

公立医院产权改革并非目前医院问题产生的内因.公立医院产权改革实质上是改变计划经济条件下形成的产权运行模式.大力推进公立医院产权改革是提高公立医院资产运行质量、优化全社会医疗资源配置、扩大医疗资源社会供给、提供政府对医疗事业调控能力的迫切需要.要顺利而又成功地实施公立医院产权改革,必须注意几个重要问题.     

让“刺头”员工为医院管理把脉

文章通过对一家公立医院“刺头”员工转化过程的研究,引发组织在医院管理认知上、制度上、执行上的反思与考量,并以此作为推动公立医院改革的切入点,实现医院管理体系的完善.     

关于深化公立医院体制改革的调研报告

当前,公立医院体制改革已经成为医院管理者十分关注的重点课题。本文通过对江苏省55所二、三级医院进行专题问卷调查,分析了公立医院的资产运营情况及904名医院领导、学科带头人和技术骨干等对公立医院体制改革的认知、心态、期望及对具体改革模式的选择等方面的看法与意见,对公立医院体制改革的时机、可行性条件、改革的方法和模式选择、政策判断等进行探讨,对公立医院体制改革的实践操作提出建议。     

长春新碱过量引起严重毒副反应1例的护理体会

报道1例霍奇金淋巴瘤患者因误用长春新碱（VCR）10mg一次性静脉推注后治疗护理情况。其出现间断性神志恍惚、眼睑闭合不全、言语不清、口腔黏膜糜烂、全身疼痛、麻痹性肠梗阻、尿潴留、手足麻木等症状,经积极解救,禁食,持续胃肠减压、胃管内注入麻油、开塞露、生理盐水灌肠,合理应用肠外营养,注重疼痛、心理护理,做好口腔、肛周护理,预防感染加重,患者病情得到控制好转出院。     

Correlates of stages of change of smoking among inhabitants of deprived neighbourhoods

BACKGROUND: This study examines the prevalence and correlates of stages of change of smoking, in terms of psychosocial, structural and sociodemographic factors, among inhabitants of deprived neighbourhoods. METHODS: Cross-sectional data were obtained from a survey on health related behaviour. Subjects were 2009 current and former smokers, aged 20-46, living in deprived neighbourhoods in Rotterdam, the second largest city in the Netherlands. Three groups of smokers were formed according to the stages of change-definitions of the Transtheoretical Model: smokers not planning to quit (precontemplators), smokers planning to quit (contemplators/preparators) and former smokers (actors/maintainers). Smokers planning to quit and smokers not planning to quit were compared regarding psychosocial factors (attitude, social norm, self-efficacy), structural factors (neighbourhood problems, material deprivation, financial problems, employment status) and sociodemographic factors (age, gender, marital status, cultural background, educational level). Former smokers were compared with smokers planning to quit regarding structural and sociodemographic factors. Logistic regression was used to assess correlates of stages of change. RESULTS: Smokers planning to quit (prevalence = 19%) reported a more positive attitude, stronger social norms and higher self-efficacy expectations in quitting smoking than smokers not planning to quit (prevalence = 57%). Smokers planning to quit less often were Dutch-born, more often had attended higher vocational schooling or university and more often reported experiencing two or more neighbourhood problems compared to smokers not planning to quit. Former smokers (prevalence = 24%) were older, more often Dutch-born, married, employed and higher educated, compared to smokers planning to quit. Furthermore, former smokers less often reported material deprivation and financial problems than smokers planning to quit. CONCLUSION: Among people living in deprived neighbourhoods, different factors correlate with different stages of change of smoking. Implications for health promotion are discussed.     

Choice of measures of vaccination and estimates of risk of pediatric pertussis

BackgroundVaccination uptake at the individual level can be assessed in a variety of ways, including traditional measures of being up-to-date (UTD), measures of UTD that consider dose timing, like age-appropriate vaccination, and risk reduction from individual doses. This analysis compared methods of operationalizing vaccination uptake and corresponding risk of pertussis infection.MethodsCity-wide case-control study of children in Philadelphia aged 3 months through 6 years, between 2001 and 2013. Multiple logistic regression was used to isolate the independent effects of each measure of vaccination uptake and the corresponding relative odds of pertussis.ResultsBeing UTD on vaccinations was associated with a 52% reduction in risk of pertussis (OR 0.48, 95% CI: 0.34, 0.69). Evaluation of delayed receipt of vaccine versus on-time UTD yielded similar results. There was a decrease in risk of pertussis for each additional dose received with the greatest reduction in pertussis infection observed from the first (OR 0.48, 95% CI: 0.28, 0.83) and second dose (OR 0.17, 95% CI: 0.08, 0.34). Additional doses conferred minimal additional protection in this age group.ConclusionExamining vaccination status by individual doses may offer improved predictive capacity for identifying children at risk for pertussis infection compared to the traditional UTD measure.     

上海市某医院骨科平均住院日影响因素分析

对上海市某医院2003年-2007年骨科出院病人的住院日描述性分析．2003年-2007年骨科的床位利用指数与平均住院日相关性分析．2003年-2007年骨科床位与医护比例分析．2007年骨科前10大病种平均住院目影响因素分别进行单因素相关性分析和多因素逐步回归分析（STATA软件）。通过对骨科10大病种住院日影响因素分析,术前等待天数、手术类型、是否输血分别对10个、9个和8个病种的住院目有影响。输血因素和手术类型是医院不可控、由病人的病情决定的,术前等待天数是管理因素,是最值得医院重视的影响因素。     

两种不同肌瘤剔除术治疗子宫肌瘤的临床疗效比较

目的:比较腹腔镜子宫肌瘤剔除术与腹式子宫肌瘤剔除术的临床疗效。方法:回顾分析63例腹腔镜子宫肌瘤剔除术与61例腹式子宫肌瘤剔除术的临床资料,比较2种手术方式的手术时间、术中出血量、肛门排气时间、使用抗生素时间、术后感染率、体温恢复正常时间、住院时间等情况。结果:两组患者接受子宫肌瘤剔除术顺利完成,腹腔镜组手术时间长于开腹组(P0.05),腹腔镜组术中出血量及剔除肌瘤个数均少于开腹组(P0.05),术后腹腔镜组体温恢复正常时间、肛门排气时间、抗生素使用及住院时间均短于开腹组,两组患者最多随访6个月,腹腔镜组平均康复时间较开腹组短(P0.05),两组随访B超均未发现明显肌瘤结节。结论:腹腔镜子宫肌瘤剔除术损伤小,恢复快,住院时间短,是值得推广的微创手术。     

尘肺病患者145例死因调查

目的分析汉中市尘肺病的发生、发展和死亡原因，以提高尘肺病患者的生存质量。方法对145例尘肺病患者的死因进行回顾性分析，计算其平均发病年龄、死亡年龄及患尘肺病后的存活年限。结果矽肺的平均发病年龄和死亡年龄均早于煤工尘肺和石棉肺，尘肺病的主要死因为患肺部疾患，患尘肺病后的平均存活年限为12a。结论加强职业健康体检工作，对尘肺病人做到早发现早治疗和预防并发症的发生。     

性发育异常发病机制的研究进展

正常的性腺分化可分为3个过程：原始性腺形成、性别决定和卵巢/睾丸发育。在任一环节中,基因表达或调控发生异常均有可能导致性发育异常疾病的发生。性发育异常是指染色体、性腺和解剖性别不典型。随着分子生物学技术的发展,不断地发现新的基因或信号通路参与性腺分化和发育,如SRY、SF1、WT1、Sox9等基因与睾丸发育密切相关,Wnt/Rspo1/B连环蛋白通路、Dax1、Foxl2等基因在卵巢分化中发挥着重要作用,一些非编码RNA和转化生长因子也有重要的调节功能,且睾丸和卵巢发育均为主动过程,即使在出生后因某些基因的改变两者间也可出现横向分化。这些为揭示性分化异常的发病机制提供了可能。     

西林瓶装注射用水的装量检查分析

为了检查西林瓶装注射用水的实际分装量是否符合2005年版《药典》三部要求,按照2005年版《药典》三部中“生物制品分装和冻干规程”,分装规格为0．8ml的西林瓶装注射用水10000瓶,随机在分装过程的前、中、后阶段共抽取100瓶,轧盖、目检。分别用1ml标定注射器及1ml普通无菌注射器抽取每瓶注射用水的实际体积,以t检验法对实际抽取量与标示量的差值进行统计学分析,结果显示其与2005年版《药典》三部要求分装附加量为0．1ml相比有显著性差异（P〈0．001）。     

One-year stability of the Measure of Processes of Care

BACKGROUND: The Measure of Processes of Care (MPOC) is a 56-item self-administered measure designed to examine what parents of a child with a chronic health problem think of the services they and their child receive, and to measure the extent to which these services are family-centred. Reliability and validity of the MPOC were established in prior studies. The aim of the present study was to assess the 1-year stability of the MPOC to justify its use as an evaluative tool. METHODS: Nine paediatric rehabilitation centres in the Netherlands participated in this short longitudinal survey study. Subjects were 205 parents (response rate 74.8%) of children aged 1-18 years who received care in one of the participating paediatric rehabilitation centres. All subjects filled out two MPOCs with a 1-year interval. RESULTS: All correlations between the scale scores of the MPOC at the first and second administration were relatively high and significant (range: 0.443-0.609, all P < 0.001), demonstrating high inter-individual stability. However, all mean scale scores, except for Providing General Information, significantly reduced after 1 year. CONCLUSIONS: The MPOC has a moderate 1-year stability. However, because of its tendency to score lower when repeated after 1 year, its use as an evaluative follow-up instrument to assess the effectiveness of a programme intervention is restricted.     

儿童皮质发育畸形的MRI诊断

目的探讨儿童皮质发育畸形(MCD)的MRI表现特点,为MCD的早期诊断提供依据。 方法选择2010年1月至2012年12月在四川省医学科学院·四川省人民医院放射科经MRI检查确诊为MCD的44例患儿为研究对象。回顾性分析及总结其MRI影像学特征。本研究遵循的程序符合四川省医学科学院·四川省人民医院人体试验委员会制定的伦理学标准,得到该委员会批准,征得受试对象及其监护人知情同意,并与监护人签署临床研究知情同意书。 结果本组44例经MRI确诊为MCD患儿中,巨脑回-无脑回为17例,多小脑回为14例,灰质异位为9例,脑裂畸形为4例。MCD的MRI特点中,巨脑回表现为脑回增宽、皮质增厚及白质变薄;无脑回表现为正常脑沟、脑回消失,皮质增厚及白质变薄;多小脑回表现为脑回增多、细小;灰质异位表现为皮质下及侧脑室周围深部白质区结节状、团块状或带状病灶,信号与灰质信号相同;脑裂畸形表现为从侧脑室到脑表面贯穿大脑半球的裂隙,表面覆盖灰质。 结论MRI是诊断儿童MCD的可靠影像学方法。