门诊量影响因素探讨

为了分析门诊量影响因素,对中山医科大学附属第三医院1998－1999年全院门诊增长情况进行回顾,对吸引病人来院就诊的主要因素进行问卷调查,其结果,该院年平均增长率为10．7％,有6个科室年增长率大于全院平均增长率。吸引病人来院就诊的主要因素依次为就近就诊、医疗水平、有熟悉的医生、定点医院、知名专科、服务热情、医院环境等;在最希望改善的8项因素中,降低收费排名第一。通过调查得出：门诊量与就近就诊、医疗质量最相关;与专科知名度、服务质量、门诊环境密切相关;医疗费用值得重视。     

提高公众对医院信任度的探讨

公费医疗实行保险后 ,病人选择就诊医院的自主性更大了 ,公众对医院的信任度将成为病人流向的一个重要因素。因此 ,提高公众对医院的信任度 ,不仅对病人恢复健康有利 ,也是医院自身发展的需要。笔者尝试应用社会心理学理论 ,探讨提高患者对医院信任度的做法 ,供同道们商榷。1     

浅谈影响构建和谐医患关系的因素及对策

医院是一个服务单位,医护人员服务的对象是患者,在服务的过程中,医患之间容易发生矛盾,分析影响医患关系的主要因素,针对具体情况采取以下的对策：（1）开展医德医风教育,转变服务观念,加强“以病人为中心”的服务意识;（2）强化技术培训,提高医护人员专业素质是保证医护人员工作质量的关键;（3）在临床工作中,医护人员要注意与患者接触中的职业艺术和修养,了解患者心理,以多种方式建立良好的沟通渠道,协调医患关系;（4）健全各项规章制度,改善医院内部环境,使患者入院就诊时有一种温暖舒适的感觉。     

我院门诊患者就诊影响因素分析

通过对我院门诊病人就诊因素问卷调查进行分析和总结原因，为医院合理配置卫生资源，使医院更好地保持竞争优势，提供科学依据。分析研究认为：①医疗质量的提高是维护医院信誉的根本，同时提高了医院的知名度；②医院名望和信誉的提高促进了就医人群的扩大；③先进的医疗设备提升了医院的综合实力和技术水平；④医疗制度改革为我院创造了机遇；⑤良好的医患关系是吸引病人重要的手段；⑥服务的便捷增加了病人的满意度；⑦就医环境的改善提高了病人就诊的舒适度和信任度。     

552名门诊患者的调查分析

目的 为了了解患者的需求，更好地实现以病人为中心，提高服务满意度。方法 随机抽取门诊患者552名进行患者选择就诊医院的影响因素和门诊患者的候诊需求等问卷调查。结果 影响患者选择就诊医院的主要因素有医疗技术水平、对医生的信任度等。患者希望得到和改进的候诊服务有健康知识宣传、随时通报就诊进展、专家医师的介绍，增设看病流程提示标识等。结论 提高医疗水平和医务人员整体素质、强化服务意识、规范医疗行为等是医院搞好以病人为中心服务的重要举措。     

计算机局域网在门诊管理上的应用

<正>如何更好地消灭医院门诊就诊中的“三长一短”现象,更好地为病人服务是各大医院所关心的问题。我院是一所大型综合性医院,日平均门诊6 000人次左右,在这种情况下,就不可避免地出现了严重的“三长一短”现象。为了最大限度地满足病人的需要,提高为病人服     

疟疾患者求医行为的影响因素研究

目的　探讨影响疟疾病人求医行为主要因素。方法　对湖南、贵州两省的５ 个县的２１２ 名在１９９６年５～１０月间新发疟疾病人进行了回顾性调查，并进行单因素与多因素分析。结果　患者就医的时间间隔为５７５天，在各类就医地点中以村卫生室频率最高（４０５７％ ），病人遵守医嘱的比例较高（７８３０％ ）。在单因素分析的基础上对患者求医去向的影响因素进行了非条件ＬＯＧＩＳＴＩＣ回归分析，筛选出的主要因素作用大小依次是去第一家医疗机构就诊的原因、去医院就医所用的时间、出现症状后病人自己及家人是否怀疑患了疟疾、发病前的疟防知识。结论　疟疾病人行为受家庭、疟防知识和医疗机构的医疗服务等因素的影响。     

发达国家医院信息系统发展研究及启示

目的结合我国当前实际,参考国外发达国家的经验,建立先进的医院信息系统,为改善病人就诊环境,赢得最优的服务效率和质量,为各级医院信息化的进一步发展提升提供参考。方法在广泛收集国内外研究成果的基础上,将理论与实证分析相结合,分析国外发达地区医院信息系统发展与我国的不同及差距,重点分析美国医院信息系统的发展。结果通过分析可以看出以下方面的差距：（1）政府的作用,（2）医院信息化的投资规模,（3）标准化的推广和保险体制的完善,（4）信息技术应用的深度和广度。结论通过对比分析,总结经验与教训以及我国须注意和改进的具体问题,得出了对我国有益的启示。     

医疗保险自助挂号系统的设计与应用

医疗保险自助挂号系统在国家全民参保的政策指导下有着广阔的应用前景,它的应用能有效改善就医环境,提高病人的就诊满意度;同时有利于医院提高服务质量,增加医院的竞争力,是建立以病人为中心的现代化医院实现自动化、信息化管理的重要环节。     

门诊挂号流程再造的实施效果分析

目的 利用门诊信息系统进行门诊挂号流程再造,采用先诊疗后收取挂号诊查费对门诊就诊流程进行优化,探讨数字化医院建设中缩短门诊患者就诊排队时间、提高门诊诊疗工作效率与服务质量的新途径.方法 ①收集我院2010年2月至2011年6月份信息系统门诊工作量及门诊挂号诊查费统计数据,统计方法采用描述性分析;②问卷调查,对2010年9月份及2011年6月份来我院门诊就医的病人采取现场随机抽查方法,统计方法采用t检验.结果 ①优化流程的挂号诊查费误差率比传统流程小（P〈0.05）;②门诊优化流程后,缩短了患者在院就诊时间（P〈0.05）,患者满意度提高（P〈0.05）.结论 新的门诊流程为医院实施信息化提供了良好的可行性途径,有利于体现＂以病人为中心＂的治疗原则,为病人提供高效优质的服务.     

Die sogenannte Vinylchlorid-Krankheit—eine berufsbedingte Systemsklerose?

Zusammenfassung Es wurden 13 Arbeiter untersucht, die zwischen 1 3/4 und 18 Jahren in einem PVC-herstellenden Betrieb beschäftigt waren. 8 von ihnen wiesen sklerodermieartige Hautveränderungen (Abb. 2) auf, die histologisch charakterisiert sind durch Verbreiterung und Homogenisierung der kollagenen Faserbündel (Abb. 3 u. 4) sowie Fragmentation und Rarefizierung der elastischen Fasern (Abb. 5). Bei 7 Patienten bestanden trommelschlegelartige Auftreibungen einzelner Fingerendphalangen (Abb. 1). 11 Patienten zeigten Durchblutungsstörungen der Extremitäten (4 von diesen ein Raynaud-Syndrom) und 6 Patienten Acroosteolysen einzelner Fingerendphalangen (Abb. 6, Tabellen 1–3).Darüber hinaus bestand bei allen Patienten eine Thrombocytopenie, bei 12 Patienten eine Splenomegalie, bei 11 Patienten eine Einschränkung der Leberfunktion (erhöhte BSP-Retention). An der Leber ließ sich histologisch bei den 5 laparoskopierten Patienten eine deutliche Fibrosierung der Portalfelder nachweisen. Bei 4 Patienten bestanden Oesophagusvaricen (Tabellen 4 u. 5). 8 Patienten zeigten eine Partialinsuffizienz mit Hinweisen für vorwiegend restriktive Veränderungen.Die hier beschriebenen Veränderungen gehen weit über das bisher bekannte Acroosteolysesyndrom hinaus. Es wird der dringende Verdacht geäußert, daß langfristige Vinylchlorid-Exposition dieses komplexe Krankheitsbild verursacht. Daher wird für diese systemische Krankheit die Bezeichnung Vinylchlorid-Krankheit vorgeschlagen.Wir danken Frau E. Voigtländer für die Herstellung der klinischen und histologischen Abbildungen.     

Empathic processes: perception by medical students of patients'' anxiety and depression

Perceptions by medical students of patients' affective states were investigated, and the effect of the students' own emotions on such perceptions. One hundred and one fourth-year medical students rated the levels of anxiety and depression of three women patients presented on videotape, rated their own levels of anxiety and depression and completed a questionnaire on aspects of the rating process. Students had widely different and often inappropriate perceptions of patients' levels of anxiety and depression. Students who consistently overrated anxiety or depression in patients, compared to those who consistently underrated, were themselves significantly more anxious or depressed. These data suggest a need in medical education for systematic teaching of empathic skills and for recognition of potential bias in clinical decision-making arising from the clinician's own emotional state.     

The reported incidence of work-related ill-health in Scotland (2002-2003)

BACKGROUND: Although incidence data for work-related ill-health in the UK are available, more detailed information for smaller geographical areas has hitherto been unpublished. AIMS: To estimate the incidence of work-related ill-health reported by clinical specialists in Scotland, 2002-2003. METHODS: THOR (The Health and Occupation Reporting network) is a UK wide reporting scheme for work-related ill-health. In 2002-2003, 241 out of 2162 physicians in THOR were based in Scotland. We have summarized the reported cases and calculated incidence rates for categories of ill-health by age, gender and industry. The UK Labour Force Survey (2002) was used to provide denominator data, with comparisons made between rates for Scotland and the rest of the UK. RESULTS: In 2002-2003, 4043 estimated cases were reported from Scotland. Mental ill-health was most frequently reported (41%); followed by musculoskeletal disorders (31%), skin disorders (16%), respiratory disease (10%), hearing disorders (2%) and infection (1%). The reported average annual incidence rate per 100,000 employees for all work-related ill-health in Scotland was 86.0. The highest reported rate for mental ill-health was found for employees in public administration and defence (76.7 per 100,000), and health and social work (72.3 per 100,000). The construction industry had the highest reported rate of musculoskeletal disorders (41.6 per 100,000), while hairdressers appeared at most risk of developing occupational contact dermatitis (rate=86.4 per 100,000). CONCLUSIONS: Despite its limitations, THOR has indicated types of work-related ill-health and related industries for targeted disease prevention in Scotland.     

Function of the protein RPE65 in the visual cycle

A protein called RPE65 performs a key role in the trans-cis isomerization of retinol in the retinal pigment epithelium of the eye. The palmitoylation of RPE65 serves to switch off the visual cycle in darkness and to switch it on in the light.     

Acute symptoms following work with pesticides

BACKGROUND: Serious accidental poisoning by pesticides is rare in the UK, but more minor pesticide-related illness may be under-reported. Anecdotally, use of sheep dip has been linked with flu-like symptoms. AIM: To explore the frequency, nature and determinants of acute symptoms following work with pesticides. METHODS: A postal survey of men in three rural areas of England and Wales provided data on occupational use of five categories of pesticide, occurrence of 12 specified symptoms within 48 h of using pesticides and tendency to somatize. Risk factors for pesticide-related symptoms were assessed by modified Cox regression. RESULTS: Of 10 765 responders (response rate = 31%), 4108 had at some time used pesticides occupationally, including 935 (23%) who reported symptoms following such work on at least one occasion. In two areas, acute symptoms were most frequent following use of sheep dip (29 and 32% of users), but in the third area the rate was significantly lower (13% of users). The relative frequency of symptoms was similar for all five categories of pesticide, and flu-like symptoms did not cluster unusually among users of sheep dip. Risk of pesticide-related symptoms increased with somatizing tendency (prevalence ratio for highest versus lowest category 2.4, 95% confidence interval 2.0-3.0) and was higher in men who had used pesticides most often or handled concentrate. CONCLUSION: Acute symptoms are common following work with pesticides, but in many cases the illness may arise through psychological rather than toxic mechanisms.     

The Life Events Inventory: re-scaling based on an occupational sample.

The objective of this study was to compare the validity of the original weightings used by the Life Events Inventory (LEI) with those obtained from a contemporary occupational sample. Fifty male and 62 female manufacturing employees (age range 16-55 years) assigned scores to each item on a slightly modified version of the LEI scale. The current sample consistently assigned higher weights to events/items than did the original sample, but there was high agreement in terms of item ranking. Some distinct age and gender differences in scoring were apparent, and are discussed further. It was concluded that when separate weightings are employed for age and gender groups, the LEI remains a useful tool for quantifying background levels of stress in both workplace stress audits and epidemiological studies where statistical control for non-occupational sources of stress is required.     

Maxillofacial injuries related to work accidents: a new concept of a hospital-based full electronic occupational trauma surveillance system

The objective of this study was to investigate the occurrence of occupational maxillofacial injuries using a newly installed relational database. Twenty-six injuries were identified out of 28,624 patients admitted to the emergency unit during a 12 month period. Falls from height or being struck by moving objects were common causes of these injuries. Two-thirds of those identified were construction workers. This paper demonstrates the power of modern databases to identify specific occurrences that may provide the basis for prevention in the future.     

Rôles physiologiques des endocannabinoïdes dans le contrôle de l’homéostasie énergétique

Endocannabinoids are endogenous lipids which modulate the release of neurotransmitters and activate different signaling pathways, through the binding to cannabinoïd receptors, CB1 and CB2. Endocannabinoids are involved in the control of a variety of behavioural and neuroendocrine functions, including feeding behaviour. In the central nervous system, they essentially modulate the expression of orexigen or anorexigen neuropeptides thus resulting in the stimulation of food intake. Their peripheral targets are mainly the liver and the white adipose tissue where they stimulate lipogenesis, through the modulation of several enzymes and proteins expressions. Cannabinoïd receptor agonists are nowadays prescribed to improve appetite of people suffering from cancer or AIDS. In the same way, CB1 antagonist, such as Rimonabant, could provide efficient treatment of obesity.     

Stress in police officers: a study of the origins,prevalence and severity of stress-related symptoms within a county police force

BACKGROUND: High levels of stress-related illness are causing concern across industry. Against a background of impending legislative moves to try to improve this situation, there is a need to identify key work-related stressors. Police work tends to be regarded as inherently stressful because of the personal risk of exposure to confrontation and violence and the day-to-day involvement in a variety of traumatic incidents. As a result, high levels of stress-related symptoms might be expected in this population. OBJECTIVE: To examine the sources of stress-related symptoms within police officers and measure the prevalence of significant associated mental ill-health. METHOD: A cross-sectional questionnaire survey of a population of 1206 police officers was performed to assess levels of strain associated with a series of potential home and work related stressors. Participants were then split into low and high scoring groups on the basis of a General Health Questionnaire (GHQ) threshold score in order to identify those stressors most associated with mental ill-health effects. RESULTS: Occupational stressors ranking most highly within the population were not specific to policing, but to organizational issues such as the demands of work impinging upon home life, lack of consultation and communication, lack of control over workload, inadequate support and excess workload in general. The high scoring group constituted 41% of the population and differed significantly from those with low scores in perception of all stressors, ranking both personal and occupational stressors more highly, and from personality constraints appeared significantly more 'stress-prone'. A significant association between gender and mental ill-health was found, with females more likely to score more highly on the GHQ than males. CONCLUSION: This study confirms previous findings of organizational culture and workload as the key issues in officer stress. Given that the degree of symptomatology appears to be worsening, management action is required. Further research is indicated within the police population into a possible increased susceptibility in female officers.