构建非直属附属医院战略联盟的探索与实践

高等医学院校非直属附属医院为学校和医院的发展带来了双赢,非直属附属医院战略联盟,把双方的合作共建、互惠双赢的局面推向了联盟成员互惠互利、合作共赢的局面.本文从战略意义的角度探讨了非直属附属医院战略联盟的建设与发展.     

医学院校非直属附属医院师资队伍建设理论研究与实践

医学院校非直属附属医院是临床教学的重要组成部分,也是医学生培养的重要基地,师资队伍建设是完善非直属附属医院教学职能、提高医学生人才培养质量的关键。文章通过分析非直属附属医院师资队伍建设存在的问题,提出了加强非直属附属医院师资队伍建设的对策与措施。     

非直属附属医院整体化临床教学建设的体会

以海南省人民医院为例,从健全教学体系、完善教学制度、创新教学模式、规范教学督导、加强师资培训、夯实教学硬件、营造教学氛围等方面介绍非直属附属医院整体化临床教学建设,取得以临床教学促进医院医教研协调发展的初步效果,总结经验以期达到促进非直属附属医院整体化临床教学建设的目的。     

适应医学教育发展充分发挥非直管附属医院教学职能

文章针对当前高等教育大发展和高等医学教育规模不断扩大的实际,就充分发挥地方高等医学院校非直管附属医院临床教学职能的重要性、必要性及其应采取的对策措施进行了探讨。可供已建有非直管附属医院的地方高等医学院校加强临床教学基地建设和充分发挥已建非直管附属医院临床教学职能,以适应当前和今后一段时期高等医学教育发展所借鉴和参考。     

高等医学院校非直管附属医院的建立与临床教学实践

本语文针对目前高等医学教育规模扩大,高等医学院校医院病床数不能满足临床教学需要的状况,在简要论述高等医学院校建立非直管附属医院的重要性,必要性和可行性基础上,扼要介绍了我校非直管附属医院建立、建设与临床教学实践的一些具体做法,可供有关院校适应高等医学教育发展,加强临床教学基地建设所借鉴和参考。     

六安市中医院成为安徽中医学院非直属附院和临床学院

2005年11月18日10：18分。安徽中医学院非直属附属医院和临床学院揭牌仪式在六安市中医院会务中心隆重举行。会上，安徽中医学院有关领导宣读了安徽省教育厅、安徽省卫生厅关于同意在六安市中医院设立安徽中医学院非直属附属医院和临床学院以及在六安市中医院建立相关教研室和聘请兼职教师的文件。     

县市级非直属附属医院科研现状及对策分析——以昆山市第一人民医院为例

该文通过以县市级江苏大学非直属附属昆山医院为例,对在科研管理建设上取得的成绩和存在的问题进行浅要剖析,并针对这些问题列举了一些主要举措进行实践性探索。为同等同类的县市级综合性非直属附属医院科研管理工作提供借鉴。     

县市级非直属附属医院建设的实践与探讨

总结县市级非直属附属医院10年建设工作的实践经验,对建设过程中遇到的问题、不足及改进举措进行了剖析,为探索医学教育改革、完善附属医院功能、提升医院科教内涵、实现院校合作共赢提供参考.     

军医大学非直属临床医学院建设的实践与思考

军医大学建设非直属临床医学院是应对军队高等医学教育结构和规模调整,加强医学生实践能力培养和临床思维训练,提高办学质量与效益的必然要求;建设非直属临床医学院,必须妥善解决校院双方的有效协作,教师的施教能力、教学意识和精力投入以及教学经费筹措等问题。     

独立教研组临床教学管理体制探讨

科学而合理的临床教学管理体制是保证临床教学质量的关键。目前大部分临床教学医院都实行临床科主任同时担任教研室主任的教学管理体制。在近三年争创医学院非直属附属医院的教学实践中，改变了临床各科主任兼管教学工作的管理体制，构建了专门的教研组，独立地开展教学工作并主持教研组的建设，与临床医疗及科研工作齐头并进，相辅相成。笔者发现，独立的教研组体系更有利于教学观念的深入，更能保证教学管理的高效率和一致性。独立教研组临床教学管理体制使我院的教学与临床工作、住院医师培训、科研和学科建设实现了平行的、全面协调发展的局面。非直属附属医院尽量实行正规附属医院的教学管理体制是保证教学质量的前提条件，也是实现医院学科发展，医疗、科研、教学共同腾飞的关键。     

The Environmental Protection Agency's brownfields pilot program

OBJECTIVE: We studied the diffusion of the US Environmental Protection Agency's national brownfields pilot innovation to more than 300 local governments between 1993 through 2002 to determine why some local governments received grants very early in the process while other awardees received funding later. METHODS: We did an ordinal regression analysis of the characteristics of all local government award recipients, and we conducted interviews with early-award recipients. RESULTS: The first set of local government awardees had lost much of their manufacturing base, had large concentrations of economically disadvantaged minority residents, and had local capacity to compete for funding. Federal and state officials catalyzed the diffusion of the innovation by working with local governments. CONCLUSIONS: The widely praised program was diffused selectively at first and then more widely later on the basis of local need, local capacity to compete, and networks of contacts among entrepreneurs and local governments. The economic, social, political, and public health impacts must be monitored and reviewed.     

Local Newspapers, Community Partnerships, and Health Improvement Projects: Their Roles in a Comprehensive Community Initiative

To understand local media's role in a community health initiative, a content analysis of 1,709 paragraphs from 173 news articles and editorials was undertaken. The articles were from three local newspapers, one in each of three communities. Analyses focused on article content combined with reflective personal interviews with local campaign directors. Results suggest that local campaign staff can be successful using commercial media to achieve objectives. Surprisingly, most coverage was not about projects with observable and easily identifiable benefits for local residents, but rather partnerships among influential residents engaged in decision-making about such projects. We conclude that the politics of resource distribution is more newsworthy to local journalists than tangible topics like access to health information, insurance coverage, and service provision.     

‘Punching above their weight’: a qualitative examination of local governments’ organisational efficacy to improve the social determinants of health

Objective : The World Health Organization calls upon local government worldwide to play a greater role in improving public health by improving the social determinants of health. This research aimed to determine how local governments in Victoria, Australia, conceptualised their organisational efficacy to address public health with reference to their statutory obligations. Methods : Sixteen in‐depth interviews were conducted with Victorian local government health planners. Thematic analysis was used to determine the importance of state health priorities and the perceived organisational efficacy of local government to address health via social determinants. Results : While there were disparities between state and local priorities for health, local government believes it can make an important contribution to improving health through ‘upstream’ approaches. Conclusions : Victorian local government has strongly adopted the socio‐ecological model of health and is aware of the important role that its diverse policy and program areas play in creating healthy communities. The Victorian State Government’s priorities, which adopted a more ‘downstream’ approach, were less influential. Implications for public health : State governments’ priority settings should be responsive to local governments’ unique local knowledge of health priorities. There is value in legislating a social determinants role for local government, provided it is supported by state and national government policies that facilitate public health.     

Local, national and imported foods: a qualitative study

The UK government is currently attempting to encourage consumers to buy more locally produced food. It is hoped that this will provide economic, environmental and social benefits to local areas, leading to more sustainable patterns of consumption. This qualitative study looks at the views and behaviour of consumers towards local foods with a particular focus on the barriers that prevent greater uptake of local produce. In total, four focus groups (n=33) were conducted. Content analysis identified six relevant themes in relation to local, national and imported foods. These were cost, lifestyle, food quality, consumer ethnocentrism, choice and farmers. Overall, although participants reported buying few local products currently, there was widespread enthusiasm across socio-economic groups for local foods, with participants perceiving them as being of a higher quality than imported foods. They also generally endorsed the idea of supporting local farmers and their own national economy. The main barriers preventing participants from buying more local products were price and inconvenience. The results are discussed in relation to developing future strategies for encouraging people to buy more local food products.     

区域性医学影像信息系统的实现策略

本文结合海南省医疗卫生行业信息化建设的实际情况，从分析建设区域性医学影像信息系统的必要性入手，论述了区域性医学影像信息系统建设目标、建设方案、系统结构、网络平台和实现策略等．作为对加快区域性医疗卫生信息化建设，建设区域性医学影像信息系统的一些初步探讨。     

Use of local area facilities for involvement in physical activity in Canada: insights for developing environmental and policy interventions

Despite growing literature showing associations of availability and accessibility of facilities to greater levels of physical activity, considerably less is known about the actual extent of use of these facilities. The purpose of this study was to examine the individual (sex, age, education and extent of involvement in vigorous physical activity) and local area characteristics (socioeconomic status, locations and number of physical activity organizations per 1000 residents) associated with the use of local facilities for involvement in physical activity. A telephone survey was conducted with 3191 randomly selected adults in 22 non-contiguous areas across Canada. Use of local facilities for involvement in physical activity was examined among a subset of 1006 physically active adults. Data were analyzed using multilevel modeling. Findings revealed significant variation across areas in likelihood of use of local facilities among women but not men. Women in the 25-34 and 45-55 age categories were significantly more likely to use local facilities than women of 35-44 years of age. Women reporting greater levels of involvement in vigorous physical activity were more likely to use local area facilities. Higher area affluence and living in areas located in small urban towns were associated with greater use of local facilities among women only. None of the individual and local area characteristics was associated with the outcome among men. Understanding the processes associated with differential use of local area facilities for physical activity is essential for the implementation of effective environmental and policy interventions to increase physical activity in the population.     

Room for manoeuvre?: Explaining local autonomy in the English National Health Service

Decentralisation has returned as a key theme in English health policy in recent years in policies such as Patient Choice and Foundation Trusts, among many others. The goal of these policies appears to be to stimulate self-sustaining incentives to continuous organisational reform and performance improvement through creating a pluralist model of local provision. However, the ability of local organisations to exercise autonomy and to deliver such performance is highly contingent upon their local context, not least in terms of existing patterns of dependencies. Explaining variation in local outcomes of national policies demands an understanding and explanation of local autonomy and its effect on performance which takes into account the role of the local 'health economy'--the local context within which organizations are embedded. It is this combination of vertical and horizontal autonomy which effectively determines the local room for manoeuvre in decision-making. The aim of the paper is to examine the local dimension of decentralisation policies. It draws from different strands of literature to discuss the room for manoeuvre of local organisations within local health economies in England with specific reference to Primary Care Trusts. It draws conclusions about the nature of decentralisation itself and the impact of such policies.     

Rationing influenza vaccine: Legal strategies and considerations for local health officials.

Despite the fact that influenza vaccine is an important health resource, the structure and organization of the US vaccine manufacturing system has produced influenza vaccine shortages or distribution delays in five out of the last six influenza seasons. These shortages have produced the need for local public health officials to develop protocols for rationing and redistributing influenza vaccine at the local community level. In so doing, local health officials are confronted with significant practical and legal constraints associated with allocating a resource that is largely not under direct government control. In the face of an impending influenza vaccine shortage, local public health departments endeavor to do three things: (1) assess the local supply of vaccine, (2) assess the local demand from high-risk community members, and (3) ensure that to the greatest extent, the limited local supply of vaccine is used exclusively by those at highest risk within the local jurisdiction. There are a number of legal tools and strategies that local health officials have at their disposal to carry out these functions. This article will attempt to outline some of the significant legal impediments and practical constraints that local public health officials face in managing influenza vaccine supply-demand issues and will offer some suggestions for strengthening their ability to effectively manage these increasingly common situations.     

Pain management of first-trimester surgical abortion: effects of selection of local anesthesia with and without lorazepam or intravenous sedation

OBJECTIVE: This prospective observational study compared the effectiveness and acceptability of three commonly used regimens to reduce pain during first-trimester surgical abortion with local anesthesia. METHOD: Women undergoing suction curettage at less than 14 weeks gestation received preoperative ibuprofen and an intraoperative paracervical block. Participants then selected (1) no additional medication (local arm), (2) sublingual lorazepam (0.5 to 1 mg, approximately 20 min preoperatively) or (3) intravenous sedation with fentanyl and midazolam (doses from 50 to 125 microg of fentanyl and 1-2 mg of midazolam). Our primary outcome was intraoperative pain as measured on an 11-point verbal rating scale (0=no pain and 10=worst pain ever). RESULTS: Three-hundred thirty women were enrolled, 105 chose local, 106 opt for lorazepam and 119 picked intravenous sedation. Mean pain scores were 6.2 for local, 6.8 for lorazepam and 5.7 for intravenous sedation. Increased preoperative anxiety, depression and expected pain and a lower volume of local anesthesia used (10 mL vs. 20 mL) were positive predictors of intraoperative pain. Using multivariable analyses to control for these confounders, plus gestational age, alcohol use and body mass index, intravenous sedation was associated with a 0.86 point lower pain score (p<.005), and the local and lorazepam groups were not significantly different. Compared with the referent group (local), participants who received lorazepam were significantly less satisfied with pain control (23.8% vs. 6% unsatisfied; OR=1.93, 95% CI=1.13 to 3.26). CONCLUSION: In women who self-selected their type of anesthesia, intravenous sedation using fentanyl and midazolam decreased pain with suction curettage under local anesthesia. Sublingual lorazepam as studied did not decrease pain compared with local anesthesia alone and was associated with more dissatisfaction with pain control.