军队中小医院国家级住院医师规范化培训

作为国家首批军队中小医院住院医师规范化培训基地,本院坚持从强化教学意识、规范教学制度出发,逐步完善师资力量建设、配套资源投入、特色课程设置、生活服务保障等要素,全力打造具有军队中小医院特色的住院医师规范化培训基地.     

新形势下军队中小医院的发展思路

为探讨新形势下军队中小医院的发展战略,本阐述了在新形势下军队中小医院面临的困境;分析了制约军队中小医院发展的原因;指出了军队中小医院生存与发展的方向。新形势下军队中小医院应该强化管理、突出特色、姓军为兵、科技兴院、优质高效。     

谈军队中小医院核心竞争力

本文分析军队中小医院内涵质量建设中的短板问题，着重从医院人才、技术、品牌、服务、设备设施等5个方面提高和规范军队中小医院的建设，提出加强内涵质量建设就是打造军队核心竞争力的关键。     

新医改背景下军队中小医院的创新发展

本文分析新医改政策对军队中小医院发展建设的影响，提出调整策略、积极应对、突出特色，向内涵创新发展转型，不断提升核心竞争能力的建设思路。     

对中小医院专科建设的一点思考

中探讨了中小医院专科建设的一些理论问题,提出专科设计的原则、思路、标准及要领,强调中小医院要切实走特色专科的发展道路。     

军队中小医院特色学科建设实践

本文通过总结坚持特色兴院、促进医院可持续发展的做法与经验,提出中小医院应注重内涵建设,做大特色强化专统,实现以特色专科为牵引,促进医院整体实力和综合保障能力提高。     

军队中小医院建设发展的思考

国家医药卫生体制改革给简编后军队中小医院发展带来了机遇和挑战。章阐述了军队中小医院在发展中要定位于军队医院的特殊性、自身力量的有限性和竞争环境的复杂性，保持整体均衡协调发展；突出专业重点，有所为有所不为，依靠特色带动；拓宽经营渠道，开发医疗市场，提高经济效益；适应医学模式的转变，更新服务理念，提高医疗质量；增强领导班子的凝聚力，调动一切积极因素等观点。     

在军队编制调整后中小医院口腔科发展策略

军队新编制运行后，中小医院科室发展面临着严峻挑战，口腔科作为医院的小科室，建设发展中的矛盾和问题更为突出。正确分析军队中小医院口腔科工作的现状，贯彻落实科学发展观，实现中小医院口腔科的可持续发展，是摆在口腔科管理者面前的重要课题。当前军队医院口腔科面临的现状是编制人员减少、保障任务加重、市场竞争激烈、设备更新缓慢等实际困难。加强军队医院口腔科发展的对策措施应从5个方面人手：①抓好口腔特色建设，树品牌效应；②探索口腔专业聘任制度，解决人才短缺；③加强与基层医疗机构的合作，为基层提供技术和人才培训支持。④强化经济管理，寻求最佳效益；⑤加大技术引进，完善服务质量。     

瞄准前沿 夯实基础 谋求学科建设新突破

按照科学发展观的要求,着眼部队医院面临的新形势和新任务,作者介绍了部队中小医院在探索扶持特色学科建设、带动全院发展方面的经验：适应本地区医疗市场的需求和部队聚焦打赢的要求,选准学科发展方向,强调特色学科建设在中小医院发展过程中的作用;对有发展潜力的学科进行重点投入,资源重组;科学培养人才,使用人才,管理人才,以人为本;强调特色学科创新意识的培养、新技术的研发、引进和应用;着眼战场需求设置特色学科,开展相关创新研究。     

中小医院图书馆的管理与服务

随着网络技术的发展和医学信息知识的普及，改变中小医院传统的医院图书馆管理体制、传统的服务方式与服务质量，加强完善对现代中小医院图书馆的社会化信息化管理与服务是中小医院图书馆的重点工作，也是信息时代现代化中小医院整体结构管理建设中不可缺少的重要组成部分。     

Evaluating the Effectiveness of Community and Hospital Medical Record Integration on Management of Behavioral Health in the Emergency Department

This study evaluated the correlation of an emergency department embedded care coordinator with access to community and medical records in decreasing hospital and emergency department use in patients with behavioral health issues. This retrospective cohort study presents a 6-month pre-post analysis on patients seen by the care coordinator (n=524). Looking at all-cause healthcare utilization, care coordination was associated with a significant median decrease of one emergency department visit per patient (p < 0.001) and a decrease of 9.5 h in emergency department length of stay per average visit per patient (p<0.001). There was no significant effect on the number of hospitalizations or hospital length of stay. This intervention demonstrated a correlation with reducing emergency department use in patients with behavioral health issues, but no correlation with reducing hospital utilization. This under-researched approach of integrating medical records at point-of-care could serve as a model for better emergency department management of behavioral health patients.     

Risk of unplanned emergency department readmission after an acute-care hospital discharge among geriatric inpatients: Results from the geriatric EDEN cohort study

Objectives

The study aims 1) to examine whether items of the brief geriatric assessment (BGA) or their combinations predicted the risk of unplanned emergency department readmission after an acute care hospital discharge among geriatric inpatients, and 2) to determine whether BGA could be used as a prognostic tool for unplanned emergency department readmission.

Methods

A total of 312 older patients (mean age, 84.6 ± 5.4 years; 64.1% female) hospitalized in acute care wards after an emergency department visit were recruited in this observational prospective cohort study and separated into 2 groups based on the occurrence or not of an unplanned emergency department readmission during a 12-month follow-up period after their hospital discharge. A 6-item BGA was performed at emergency department admission before the discharge to acute care wards. Information on incident unplanned emergency department readmission was prospectively collected by phone call and by consulting the hospital registry. Several combinations of items of BGA identifying three levels of risk of unplanned emergency department readmission (i.e., low risk, intermediate risk and high risk) were examined.

Results

The unplanned emergency department readmission was more frequently associated with a temporal disorientation (P=0.004). Area under receiver operating characteristic curves of unplanned emergency department readmission based on BGA items and their combinations ranged from 0.53 to 0.61. The best predictor of unplanned emergency department readmission was the temporal disorientation (hazard ratio>1.65, P<0.035), which defined the high-risk group. Inpatients classified in high-risk group of unplanned emergency department readmission were more frequently readmitted to emergency department than those in intermediate- and low-risk groups (P log Rank <0.004). Prognostic values for unplanned emergency department readmission of items and their combinations were poor with sensitivity below 67%, specificity ranging from 36.4 to 53.7, and positive likelihood ratio below 1.4.

Conclusions

The items of BGA and their combinations were significant risk factors for unplanned emergency department readmission, but their prognostic value was poor.

     

Factors Associated With Emergency Department Utilization By Urban Lesbian, Gay, And Bisexual Individuals

There are no published studies to date on emergency department (ED) utilization by the lesbian, gay, and bisexual (LGB) community despite documented lack of access to health care for this community. This study explored the frequency of ED visits and socio-demographic and health-related factors associated with ED utilization among a convenience sample of LGB individuals. A sample of 360 LGB individuals was interviewed to assess socio-demographics, sexual practices, mental health, drug use, chronic disease history, and frequency of emergency department use. Emergency department utilization was categorized as 0, 1, or ≥2 visits. Bivariate statistics were applied to assess the association of various factors with emergency department utilization. Patient characteristics were as follows: age, 29.0; male, 53.1 percent; Hispanic, 57.8 percent; Black, 37.2 percent; and reported less than a college degree, 79.4 percent. Most (77.7 percent) had a primary care doctor and (86.3 percent) were comfortable discussing LGB-related health issues with their provider. Over 12 months, 25.3 percent had 1 ED visit and 16.4 percent had ≥2 ED visits. One or more emergency department visits was significantly associated with lower age, lower education, lower income, recent psychological distress, recent mental health counseling or medications, desired mental health treatment, abuse by partner, cigarette use, marijuana use, and asthma (p < 0.05). Despite reported access to primary care, our LGB sample exhibited a higher proportion of single and ≥2 ED visits than comparable populations. Mental health and cigarette use were associated with emergency department utilization and deserve further exploration for reducing emergency department visitation by and improving emergency department care for LGB individuals.     

洁净手术部的医院感染管理

目的 探讨提高洁净手术部医院感染管理工作水平的方法.方法 从洁净手术部的建设标准入手,运用空气和物体表面微生物的理论,论述了洁净手术部医院感染管理的艰巨性、复杂性、专业性和法规性.结果 严格规范洁净手术部的建设标准,是做好医院感染管理工作的坚实基础;坚持介入洁净手术部的工程质量验收,是做好医院感染管理工作不可缺少的重要环节;全面开展洁净手术部的日常监控,是做好医院感染管理工作的有效手段;努力创新洁净手术部现代管理模式是做好医院感染管理工作的精髓.结论 洁净手术部的医院感染管理,必须要强调全方位控制细菌的综合措施,要规范净化空调保障体系,实施全过程监控.     

科室满意度测量的应用实践与体会

从科室满意度测量对象及方法、测量结果分析及应用2方面,阐述了满意度测量在采供血机构科室管理中的应用实践。指出,科室满意度测量要常态化、制度化、规范化,要与相关制度配套衔接;科室管理模式要不断探索与创新,以提升科学化管理水平。     

254株鲍氏不动杆菌的分布及耐药性

目的 了解医院痰标本分离出鲍氏不动杆菌的科室分布及药敏结果,为临床合理用药提供参考.方法 收集医院2009年5月-2011年8月送检痰标本中分离出的254株鲍氏不动杆菌,并比较检出鲍氏不动杆菌科室的分布及药敏结果.结果 3455份痰标本共检出鲍氏不动杆菌254株,检出率为7.4％;鲍氏不动杆菌主要分布于ICU,占47.6％,其他依次为神经外科、呼吸内科、神经内科、肿瘤科,分别占18.1％、15.7％、11.8％、2.8％;鲍氏不动杆菌对15种常用抗菌药物中14种普遍耐药,平均耐药率高达79.6％,仅对头孢哌酮/舒巴坦表现出较敏感,敏感率为73.6％;ICU、神经外科、呼吸内科、神经内科的多药耐药、泛耐药菌株检出率显著高于其他科室(P＜0.05).结论 痰标本中鲍氏不动杆菌耐药率较高,其中多药耐药株、泛耐药株占有很高的比例,临床应引起高度重视;一旦发现感染耐药株,必须迅速采取控制措施,控制医院感染的蔓延.     

Social determinants of health,emergency department utilization,and people with intellectual and developmental disabilities

BackgroundPeople with intellectual and developmental disabilities’ (IDD’s) health is largely dependent on the government services they receive. Medicaid managed care has emerged as one mechanism used to provide services to people with disabilities in an attempt to reduce costs. In managed care, there has been an emphasis on reducing emergency department visits and hospital admissions in an effort to reduce expenditures.ObjectiveThe purpose of this exploratory study was to examine the impact social determinants of health –“conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks” (n.p.)¹ – had on the emergency department utilization of people with IDD.MethodsWe had the following research question: what is the relationship between social determinants and emergency department utilization (visits) among adults with IDD? To explore this research question, a negative binomial regression analysis was used with secondary social determinant outcomes data (from Personal Outcome Measures®) and emergency department visit data from a random sample of 251 people with IDD. We also examined relationships with participants’ demographics.ResultsOur findings revealed for every one unit increase in the number of social determinant outcomes present, there was a 7.97% decrease in emergency department visits. There were also significant relationships between emergency department visits, and complex support needs, intellectual disability level, primary communication method, and residence type.ConclusionsSocial determinants are critical to promote the quality of life and health equity of people with IDD.     

急诊科护士心理评估与分析

目的了解急诊科护士心理状况。方法应用自评量表(SCL-90)及自制压力源调查表对58名急诊科护士及60名普通病房护士进行问卷调查,并进行对比分析。结果急诊科护士SCL-90量表中的躯体化、强迫、抑郁、焦虑因子分显著高于普通病房护士(P<0.05)。结论与普通病房护士比较,急诊科护士显示出较多的身心问题,主要与急诊的工作性质和工作环境有关,使急诊科护士长期处于应激状态。     

Emergency department performance at a small rural hospital: An independent in‐depth review

Objectives: This study aims to provide a retrospective review of the recent performance of the emergency department of Cobram District Hospital, a small rural hospital located on the border of Victoria and New South Wales. Design: Retrospective review. Setting: Small rural accident and emergency department. Intervention: All available data collected from the emergency department from the previous three financial years (July 2005 to June 2008) were compiled onto a computerised spreadsheet and analysed by two independent investigators. Main outcome measures: Key performance indicators, including time for patient to be seen by a doctor and frequency of patient presentations to the emergency department. Results: Cobram District Hospital has fewer than 5000 patients presenting to the emergency department each year. 12 p.m. to 12 a.m. accounts for 69% of all presentations, with three notable time periods that experience most presentations. Life‐threatening emergencies represented <3% of all presentations to the emergency department. Patients in triage categories 1–3 did not met Australasian triage scale (ATS)‐suggested time for maximum waiting timing, while categories 4 and 5 well exceeded ATS standards. Conclusion: The small size and lack of dedicated emergency department staff place restrictions on the ability of an unfunded rural hospital to match the performance of major metropolitan emergency departments. ATS guidelines should be revised to improve clarity and reflect the different performance capabilities between metropolitan and rural centres.