地震救援药品管理方式初探

回顾国际救援队历次地震救援药品保障情况,根据地震药品保障特点及药品保障需求,总结工作中的经验和不足,建立贴近实际的救援药品管理方式.地震救援药品管理方式的建立,对提高救援药品的使用效率、最大程度地发挥药品作用十分重要.     

地震救援药品管理方式初探

回顾国际救援队历次地震救援药品保障情况,根据地震药品保障特点及药品保障需求,总结工作中的经验和不足,建立贴近实际的救援药品管理方式.地震救援药品管理方式的建立,对提高救援药品的使用效率、最大程度地发挥药品作用十分重要.     

使用喹诺酮类抗生素人畜的排泄物对环境的污染

喹诺酮类抗生素化学性质较为稳定且原型排泄率高,大量研究显示,人畜服用喹诺酮类抗生素后,其排泄物中残留的该类抗生素的生物活性对生态环境和人群健康的影响具有重要意义;同时,资料显示目前临床上面临该类抗生素耐药率高且快的严峻局面,可能与其环境污染特性有一定的相关性;鉴于全球对抗生素使用者排泄物管理均是空白,为降低微生物抗生素耐药威胁人类生存的风险,控制、管理并解决抗生素人畜排泄物环境污染问题刻不容缓.

Abstract：

Quinolines antibiotics present stable chemical properties ,higher excretion of prototype drug. Most of quinolines antibiotics used by human and animals show original and various biological activity forms in the excrement,which is important to ecological environment and human health. The data indicate that the present clinical treatment is facing frequent occurrence and higher rates of quinolines antibiotics-resistance, which is related to environmental pollution by quinolines antibiotics. So far as little research is focused on the management of the excrement from human and animals using quinolines antibiotics, and the control, management of the residues of excrement are very important for reducing the risk of antibiotic-resistance in human.     

深圳市公立医院法人治理改革探索

分析了目前公立医院体制机制方面存在的问题,按照"政事分开、管办分开、医药分开、营利性与非营利性分开"的改革原则,制定了公立医院法人治理改革实施路径.一是建立公立医院管理委员会,统筹政府办医保障职能;建立公立医院管理机构,提高举办医院的行政管理水平;转变卫生行政部门职能,形成多元化办医格局.二是建立分级决策机制、自主经营制度及多元监管制度,解决政事分开问题.三是研究制定公立医院章程,促进公立医院向法定机构转变,通过法制化巩固法人治理改革成果.

Abstract：

Analysis of setbacks found in the existing system and mechanism of public hospitals. Based on the health reform principles of "Separation of administration and management, Separation of administration and operation, Separation of prescribing and dispensing, and Separation of for-profit hospitals and nonprofit hospitals", the authors named the following roadmap for public hospital governance reform. First, set up a management committee for each public hospital to coordinate the government function for medical service; set up a public hospital authority to upgrade the management level of these hospitals; transform functionality of health authorities to encourage diversity in medical service providers. Second, establish the tiered decision making mechanism, autonomous operation system and diversified supervision system, to separate administration and management. Third, formulate articles of association for hospitals to encourage their evolution to legal entities, consolidating the government reforms by legal means.     

医师手术权限管理研究

依据医疗技术临床应用管理相关要求,提出医师手术分级管理的具体实施办法,包括建立手术分级项目录库、制定手术分级管理制度及手术权限申报、审核程序、调查确定医师目前具有的手术权限的步骤,提出在实施手术权限管理中存在和发现的问题及解决措施,为防范手术风险、提高手术质量、科学评价手术医师,提供管理经验及参考.

Abstract：

According to the related requirements of medical technology clinical application management, the specific implementation approaches of surgery physicians surgery permission management were made, including establishing surgery classification project directory library, developing surgery classification management system and the surgery permission declared, and audit program, and investigating to determine the steps of surgery permission owned by surgery physicians currently, and finding problems and solution measures in implementation surgery permission management. To prevent surgical risk, improve the quality of operation, and evaluate surgical doctors scientifically, it provides management experience and references.     

国内外临床路径变异管理的现状分析

文章通过对国内外临床路径变异管理的指标、结果及应用,方法和步骤,技术几方面的现状分析,得出在我国临床路径变异管理中应注意以下几方面的工作,如变异的内涵需要进一步明确、变异分析指标需要进一步具体化和变异分析指标需要进一步具体化.

Abstract：

The authors analyzed the status quo of the indicators, outcomes and uses,methodology, procedures and technologies of the variations management of clinical pathways in China the abroad. The outputs of the study point to the following assignments in such a management, such as further identification of the contents of such variations, and further clarification of variation analysis indicators.     

PDCA管理在药物不良反应监测中的应用

目的 医疗质量管理的核心是保证患者安全,用药安全则是实现这一目标的关键因素.综合医院做好药物不良反应监测,调动医务人员主动上报药物不良事件并持续改进,是医院安全文化面临的挑战.方法　通过采用PDCA循环医疗质量的管理方法,制定药物不良反应上报标准,分析我院2005年～2009年药物不良反应监测情况,提出持续改进的措施.结果　5年来,我院上报各种药物不良反应2 850例次,平均每年570例次,住院患者药物不良反应发生率为3.28%.其中严重药物不良反应43例次,发生率为0.49‰,占药品不良反应的比例为1.51%.我院在药物不良反应监测数量和质量上逐年提高,初步形成了用药安全文化.结论 PDCA循环管理可以有效地改进医院药物不良反应监测工作,提高医务人员主动上报的自觉性.针对药物不良反应发生各个环节的持续循环管理,可以最大程度地降低风险、保证患者医疗安全.药物不良反应漏报及其改进措施将是今后医院做好此项工作的重点.

Abstract：

Objective Patient safety is key to quality of care in hospital management, for which drug safety is critical. General hospitals are challenged with how to monitor drug adverse reaction (ADR), and motivate their staff to report ADRs in building a hospital safety culture. Methods The PDCA cycle quality improvement process was called into play, to set the ADR criteria and analyze data of inpatients' ADRs from 2005 to 2009, which was followed by measures proposed for ADR continuous improvement. Results A total of 2850 ADR cases were reported in the past 5 years, averaging 570 cases per year. The ADR incidence rate was 3. 28%, of which 43 were severe ADR cases, or 0. 49% of the total cases, accounting for 1. 51% of all the ADR cases. Year to year, the quantity and quality of ADR reporting have been improving in the hospital, witnessing an initial culture of drug safety. In 2008, the hospital was awarded as an advanced ADR center in Beijing. Conclusion The PDCA cycle is an effective means for ADR management, as it can improve the awareness of the medical staff for proactive ADR reporting. Sustained circular management against ADRs can minimize risks and maximize patient safety.Under-reporting and the corrective measures shall be watched over by the hospital in the future.     

基于集团化的社区卫生服务管理模式研究

发展基于社区卫生服务的基本医疗卫生服务体系是新医改的重要目标之一,建立基层医疗机构管理服务新机制是浙江省新医改的创新和有益的探索.阐述了目前基层医疗机构管理服务现状,重点论述了杭州市某区卫生局从2007年底积极开展社区卫生服务集团化管理的"九‘化'模式"的具体策略和获得的主要成效,为探索区域内社区卫生服务机构的集团化管理,为完善以社区卫生服务为基础的新型城市基层医疗卫生服务体系,提供模式参考.

Abstract：

Full-speed development of the primary health care centering on community health service is key to the ongoing health reform in China. Building a new management mechanism for these grass-root health centers is an innovative approach of such a reform as carried out in Zhejiang province.The authors described the present management mechanism in the province, and focused on the specific measures and main outcomes of the "nine Group-scale model" as used by a district health bureau in Hanzhou since end of 2007. The paper aims at building an ideal model for group-scale management of community health centers, and improving the new city primary health care system centering on community health service.     

社区高血压患者健康管理药物治疗和直接医疗费用分析

目的 调查社区高血压患者健康管理的药物治疗费用、住院费用及直接医疗费用的现状,为进一步评估国家基本公共卫生服务项目中的社区高血压患者健康管理是否具有卫生经济学上的成本效益奠定基础.方法 通过整群抽样的方法在5省10个调查点调查了8326例高血压患者,其中参与社区高血压患者健康管理1年以上的管理组对象3967例,未参与该管理的对照组4359例.通过问卷调查收集研究对象基本信息,并回顾性收集其在过去1年内(2009年11月至2010年11月)的医疗成本信息.分别对比分析两组患者的年度药物治疗费用、住院治疗费用和直接医疗费用.结果 高血压患者年均药物治疗费用为(621.50±1337.78)元,管理组为(616.13±1248.40)元,对照组为(626.44±1414.30)元.高血压服药患者年均药物治疗费用为(702.05±1401.79)元,管理组为(688.50±1300.70)元,对照组为(714.64±1489.60)元.城市高血压服药患者年均药物治疗费用[(731.88±1403.31)元]高于农村[(407.44±1171.44)元].高血压患者的年住院率为12.2%(1014/8326),高血压住院患者年人均住院费用为(9264.47±18 088.49)元,管理组[(7583.70±13 267.00)元]低于对照组[(11 028.00±21 919.00)元].高血压患者年人均住院费用为(1064.87±6804.83)元,管理组[(936.73±5284.90)元]低于对照组[(1181.50±7937.90)元].高血压患者年人均直接医疗费用为(2275.08±8225.66)元,管理组为(2165.10±6564.60)元,对照组为(2375.20±9487.60)元;城市地区患者年人均直接医疗费用[(2801.06±9428.54)元]高于农村[(1254.70±4990.27)元].结论 高血压社区健康或规范化管理能降低高血压服药患者年均药物治疗费用和患者年人均住院费用约26元和245元;节省高血压患者年人均直接医疗费用约210元.国家医疗卫生体制改革和发展中,应进一步加强和推广社区高血压患者健康或规范化管理.

Abstract：

Objective To investigate the current situation of drug cost,hospitalization cost and direct medical expense in community health management of hypertensive patients,in order to lay foundation for evaluating whether the community health management in basic public health service has cost-effect in Health Economics.Methods A total of 8326 hypertensive patients from 10 survey pilots in 5 provinces were selected by cluster sampling methods,including 3967 patients who took part in community health management for over 1 year as management group and 4359 cases who have never taken part in community health management as control group.The essential information of research objects were collected by questionnaire; and the medical cost information in the last year(from November 2009 to November 2010) were collected retrospectively.The different annual medical treatment cost,hospitalization cost and direct medical expense in the two groups were compared and analyzed.Results The average annual drug cost in hypertension was(621.50±1337.78) yuan per patient; while the cost was(616.13±1248.40) yuan in management group and(626.44±1414.30) yuan in control group respectively.The average annual drug cost of hypertensive patients who took medicine therapy was(702.05±1401.79) yuan per person,while the cost in the management group ((688.50±1300.70)yuan) was much lower than it in control group ((714.64±1489.60)yuan).The annual average drug cost in urban was(731.88±1403.31) yuan per person,which was higher than it in rural as(407.44±1171.44) yuan per person.The average hospitalized rate was 12.2%(1014/8326),and the average annual cost among the hospitalized patients was(9264.47±18 088.49) yuan per person; while the cost was(7583.70±13 267.00) yuan in management group,which was lower than it in control group as(11 028.00±21 919.00) yuan.The average annual hospitalized cost in hypertensin was(1064.87±6804.83) yuan per person; while the cost was(936.73±5284.90) yuan in management group,which was lower than it in control group as(1181.50±7937.90) yuan.The average annual direct medical expense in hypertension was(2275.08±8225.66)yuan per person; while the expense was(2165.10±6564.60)yuan in management group and(2375.20±9487.60)yuan in control group.The average annual direct medical expense in urban((2801.06±9428.54)yuan per person) was higher than it in rural((1254.70±4990.27)yuan per person).Conclusion The community health or standardized managment of hypertensive patients can reduce the average annual drug cost and hospitalization cost (around 26 yuan and 245 yuan separately); and thereby save the annual direct medical expense per capita in hypertension (around 210 yuan). In the reform and development of national medical health system, we should enhance and promote the standardized community health management of hypertensive patients.     

A Probabilistic Approach to the Evaluation of Seismic Resilience in Road Asset Management

Road networks are classified as critical infrastructure systems.Their loss of functionality not only hinders residential and commercial activities,but also compromises evacuation and rescue after disasters.Dealing with risks to key strategic objectives is not new to asset management,and risk management is considered one of the core elements of asset management.Risk analysis has recently focused on understanding and designing strategies for resilience,especially in the case of seismic events that present a significant hazard to highway transportation networks.Following a review of risk and resilience concepts and metrics,an innovative methodology to stochastically assess the economic resources needed to restore damaged infrastructures,one that is a relevant and complementary element within a wider resilience-based framework,is proposed.The original methodology is based on collecting and analyzing ex post reconstruction and hazard data and was calibrated on data measured during the earthquake that struck central Italy in 2016 and collected in the following recovery phase.Although further improvements are needed,the proposed approach can be used effectively by road managers to provide useful information in developing seismic retrofitting plans.     

突发事件应急药品保障管理系统研发

本文通过突发事件应急药品保障管理系统的研发,实现应急药品模块化保障,探讨突发事件应急救援药品保障新模式。     

抗震救灾医学救援中的卫生物资保障

医学工程保障是有效组织实施抗震救灾医学救援的关键环节之一。本文结合本源参与汶川、芦山抗震救灾医学救援的实践,从医疗物资筹措的方法和渠道、保障临床物资需求、调配和检修设备、消毒供应保障等方面提出了具体做法。     

我国药品费用不合理增长的"四大"源头及对策思考

针对我国药品费用不合理增长的迅猛势头,剖析了引起药品费用不合理增长的四大源头：政策源头是国家缺乏对药品工业宏观控制;裣源头是医院组织行为的扭曲;直接源头是医师商业性处方行为和后的传统处方行为;根本源头是患者是对药品资源的无限需求和无费用意识。并探讨控制四大源头的相对对策。     

新疆179家医院突发事件医疗救援应急物资管理现状调查

  目的  分析新疆各级医院应对突发事件医疗救援应急物资管理现状,为完善应急预案体系建设提供依据。
  方法  横断面调查新疆179家二级及以上医院,调查内容包括应急资金及物资管理、急救设备配备等情况,对数据进行统计分析。
  结果  179家医院中,制定应急资金储备计划、应急资金管理制度和设立应急资金的医院均不足40%。80%以上的医院配备了简易呼吸球囊、心电除颤仪、心电监护仪、心电图机、微量泵、吸痰器、洗胃机,70.39%的医院配备了便携式呼吸机,72.63%的医院配备了气管插管镜,35.75%的医院配备了心肺复苏机,47.49%的医院配备了喉罩,58.10%的医院配备了便携式B超机。医院能够对各类污染物进行消毒净化的比例均不超过50%。有自备供水、供氧、供电设备的医院均超过50%。三级医院在应急物资管理制度及储备和调用制度的制定率和自备供水、供氧、供电设备的配备率上优于二级医院（P < 0.05）。
  结论  新疆各级医院应急救援物资管理现状不容乐观,突发事件医疗救援应急资金储备、设备管理体系建设不完善,急救设备配备不齐全,消毒净化能力薄弱,各级医院应该进行标准化的配置。
     

突发公共卫生事件应急物资管理的实践与探讨

在突发公共卫生事件的处置过程中,应急物资的储备管理对救治工作起着至关重要的作用。2020年初的新冠肺炎疫情来势汹汹,恰逢春节假期物流繁忙,物资供应链不通畅,但需求剧增,面对供不应求的处境,应急物资管理再次成为时下讨论的热点。文章结合我院在此次抗击新冠肺炎疫情过程中物资保障工作的实践,提出了新形势下应急物资的相关管理方法和思路。     

学校公用饮用水供给方式可行性研究

目的对上海市闵行区学校公用饮用水供给方式进行调查,为寻找科学合理安全的学校饮水方式提供依据。方法学校饮水基本情况来源于上海市闵行区疾病预防控制中心相关管理科室,选用纳滤（简称NF）处理供水方式进行相关研究。结果学校供水方式主要有桶装水、开水与管道直供水等;水质污染以桶装水为主,主要为细菌总数超标,合格率低的仅为11％,最高也仅为75．72％;长远来看,桶装水成本较直供水要高,管理相对繁琐。结论纳滤处理＋臭氧消毒的全封闭供水方式建造与日常维护成本较低且相对安全,是一种比较理想的学校供水方式。     

我国应急药品供应管理体系分析——基于政策网络理论视角

为建立及时、合理、有效的应急药品供应管理体系,应用政策网络理论分析我国现行应急药品供应体系存在的问题,发现政策网络理论适用于分析我国的应急药品管理体系。基于政策网络理论视角,我国的应急药品供应管理体系还需明确各级政府的责任,加强药品应急工作的资金保障和法律保障,构建应急药品政策网络的公共信息平台。此外,药品应急工作需要在一个主体结构关系稳定,利益均衡和资源整合的网络中良性运行,以获得合理高效的发展。     

国际救援中消毒供应科应急救援储备模块的应用研究

目的 探讨国际救援中消毒供应科应急救援储备模块的应用.方法 根据平时应急卫勤演练及实战任务要求,采用建立医院内消毒供应科应急救援日基数储备数据明细表法,根据实战实际,计算消毒供应携行最大的物资需求.结果 通过建立消毒供应应急救援日基数储备数据,为救援人员物资准备提供了详细的物资目录及携行量,结合战备拉动模拟任务,有效达到在既定时间内快速、准确地完成出库、集装、送达的技术流程,保证了应急救援储备物资效期内质量安全及应急调配.结论 建立消毒供应应急救援储备模块技术,有效提升了消毒供应应急能力,达到应急救援预期效果.