公立医院危机类型及成因分析

随着医疗卫生体制改革的不断深化,政府进一步拓宽了公立医院的服务内涵和范围,但与之不相匹配的是由于各种因素引发的不同类型危机事件,对公立医院的运营发展提出了严峻考验。本文通过对公立医院危机类型的分类及危害性的研究,提出形成公立医院危机事件的主要原因,以此引起对公立医院危机管理工作的关注与思考,从而加强危机管理与防范工作,确保公立医院健康运行。     

我国公立医院危机管理研究——以武汉大学中南医院为例

公立医院正确认识社会存在的各种危机,明确选择正确的方式应对是其能否在激烈的市场竞争下生产的重要途径。公立医院将危机所带来的损害降到最低就必须正确认识公立医院危机的类型以及诱发的原因,并且根据自身医院的实际情况来量身制定合理的应对措施。     

公立医院经营策略与发展趋势探讨

随着医疗卫生市场对外开放、外资和民营医院异军突起,合作医疗制度及社区卫生服务全面推进,公立医院现行经营模式受到强烈冲击。公立医院亟待更新经营理念,寻找发展契机,确保医院的良性发展。该文针对公立医院的经营现状进行了探讨,总结了公立医院在经营中存在的问题,阐述了医院经营管理体制改革的方向和思路,提出了公立医院经营发展的趋势与对策。     

公立医院经营策略与发展趋势探讨

随着医疗卫生市场对外开放、外资和民营医院异军突起,合作医疗制度及社区卫生服务全面推进,公立医院现行经营模式受到强烈冲击。公立医院亟待更新经营理念,寻找发展契机,确保医院的良性发展。该文针对公立医院的经营现状进行了探讨,总结了公立医院在经营中存在的问题,阐述了医院经营管理体制改革的方向和思路,提出了公立医院经营发展的趋势与对策。     

宁夏回族自治区公立医院与民营医院经营效率

目的比较2012—2017年宁夏回族自治区公立医院和民营医院的经营效率,分析影响因素,为提高不同所有制医院的经营效率提供依据。方法用数据包络分析和Malmquist指数计算宁夏回族自治区公立医院和民营医院的经营效率,用广义矩估计分析不同所有制医院经营效率的主要影响因素。结果宁夏回族自治区公立医院和民营医院的经营效率有待提高,公立医院的经营效率高于民营医院。医院所在县(区)的人均国内生产总值、人均可支配收入、总人口数、实际占用总床位日数、职工总人数对公立医院和民营医院的经营效率有不同程度的影响,外部因素对民营医院经营效率的影响大于对公立医院经营效率的影响。结论宁夏回族自治区的民营医院快速发展,但投入产出较公立医院仍有一定的差距,可从政策制定、人才计划及服务质量方面加大对民营医院的扶持力度,吸引更多的社会资本进入医疗卫生领域。公立医院与民营医院的经营效率有待进一步提高,可从医院现代管理制度的实施完善、人才培养及品牌建设方面入手。影响公立医院与民营医院经营效率的因素趋同化与差异化并存,应采取有针对性的措施,达到提升医院经营效率的最终目标。     

新医改形势下中西部地区地市级公立医院发展应对策略

为应对国际金融危机,我国出台了一揽子经济刺激方案,医改政策加强了对基层医院的财政投入,打破了原有的医疗服务市场格局,特别是对中西部地区地市级城市公立医院的影响已初露端倪。县及县以下基层公立医院在国家巨额财政投入的拉动下,基本建设发展速度明显快于地市级公立医院,使地市级公立医院面临新的危机。这两大医疗市场的格局是此消彼长还是共同发展,本文试图立足国情,以科学发展观为指导,构建以地市级公立医院为龙头的泛集团化管理框架,探索一条以人为本,全面协调可持续发展的道路。     

公立医院经营战略的思考

针对我国公立医院经营中普遍存在的问题，提出了公立医院在经营中为什么要制定经营战略；制定经营战略要从转变经营观念、突出特色、立足服务、培养人才等方面思考。     

新形势下公立医院资本经营及优化策略探讨

随着医疗服务市场竞争的加剧和公立医院改革的不断深入，资本经营成了公立医院发展的必然选择。本文首先阐述了公立医院资本经营的基本理论，并就当前医院资本筹集、投资、增值和分配的具体内容进行了详细分析，最后从加快公立医院产权改革、提高财务管理水平、推进医疗服务价格调整、完善配套措施建设和培养专业人才角度提出优化公立医院资本经营的对策建议。     

构建公立医院财务风险预警模型的探讨

财务风险是公立医院经营活动过程中面对的一个现实问题,通过分析公立医院财务风险的内涵和现状,依据财务风险评估指标的设定原则和程序,探讨构建公立医院经营活动中关于财务风险的预警模型,以期及时有效地阻止或抑制财务风险事态的发展,减少财务风险的损失,促进公立医院健康、持续发展。     

2001—2007年天津市公立医院经济运行状况分析

目的:通过对天津市公立医院2001—2007年经济运行状况的分析,了解其经济运行中存在的问题。方法:通过整群抽样选取天津市29家公立医院进行问卷调查。结果:天津市公立医院经济运营较为稳定,经营效率平稳增长。结论:天津市公立医院存在政府投入不足、经营效率低下等问题,提出了控制医院发展规模、强化政府投入等政策建议。     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.