恶性肿瘤规范化诊疗质控结果分析

目的 了解恶性肿瘤规范化诊疗存在问题,并提出改进措施.方法 对282份恶性肿瘤患者的住院病历进行质控检查.结果282份病历中,有129份病历存在诊断不规范问题,占45.75％;有9份诊断依据不充分,占3.19％;有142份治疗不规范,占50.36％.临床医师专业知识掌握不全面,三级医师查房制度落实不到位,首诊医师随意选择治疗方案,是造成恶性肿瘤诊疗不规范的原因.结论 应加强医师学习与考核力度,严格执行三级医师查房制度,严格落实专科专治与多学科协作制度.     

基层医院如何落实三级查房制

医疗质量是医院管理工作的主要内容,而临床三级查房是医院最基本、最重要的基础医疗工作。随着医学科学技术的发展,三级查房质量管理的内容不断丰富,但基层医院每天面对繁忙的临床医疗任务,高级职称的医师相对较少的实际情况,如何真正落实三级查房制度,提高医疗质量,需要我们根据现实分析原因,制定对策。 1 临床三级查房中存在的主要问题 (1)质量不高:表现为临床医师对病人的病史询问不认真,查体不仔细,病情分析不全面,造成误诊误治或延误治疗;对手术病例术前讨论分析不充分,术后意外发生率升高等致使部分住院病人治疗好转率下降,医疗意外时有发生,医疗费用增加,医疗差错、     

195份住院病历三级医师查房质量评价结果分析

三级医师查房是病人能否得到及时确诊治疗的关健 ,也是上级医师对下级医师进行临床教学的一种重要形式。医院管理者和卫生行政管理部门十分重视三级医师查房质量 ,将三级医师查房质量作为考核和评价医院医疗质量和医师业务水平的主要指标。为了了解二、三级医院三级医师查房的质量 ,寻求提高三级医师查房质量的措施 ,省卫生厅随机抽查了 13所综合、专科医院的 195份内、外、妇、儿科病历 ,组织有关专家对这些病例中三级医师查房的质量进行评价 ,并对存在的缺陷和问题进行分析。现报告如下。1　资料来源全组病历总数 195份。内科病历 75份 ,…     

我院业务院长查房的创新做法

我院开创性实行业务院长综合性业务查房 ,是将业务查房与医疗管理结合起来的一种创新形式。其主要做法是 :由业务院长牵头 ,并与医疗有关的职能部门负责人及部分临床医技科室主任组成专家督查组 ,到科室现场查房。这是全面了解临床、医技科室业务工作与管理情况 ,落实三级医师负责制 ,全面控制医疗质量 ,培养和考核各级医务人员 ,进行病案环节质量控制和医疗安全监控的有效方法     

院长业务查房的做法及对医疗质量的影响

实行了业务院长带领与医疗有关的职能科室负责人和临床医疗、药学专家进行综合性业务查房。这种具有前馈质控、环节质控的查房模式,强化和完善了院长查房在医疗质量控制中的作用,是全面、及时了解临床科室业务工作,落实三级医师负责制,全面控制医疗质量,培养和考核各级医护人员、进行病历环节质控和医疗安全监控的有效方法。     

提高三级医师查房质量的探讨

在日常的医疗工作中 ,最能够反映医院医疗质量水平的是最常见的三级医师查房。笔者参加了对全国2 2所三级甲等医院创建“百佳”的验收工作 ,检查中发现所有被检医院的三级医师查房质量均不同程度地存在一些问题。1　存在的问题1.1　主任 (副主任 )医师查房情况查房记录中 ,内容比较单调 ,知识面不够宽 ,流于形式 ,没有反映出查房者的真实水平。多数查房记录内容苍白 ,就事论事 ,既无对所查疾病的鉴别诊断 ,又无当前国内、外对该病的最新疗法和检查手段等。最常见的是“×××主任看病人”,或“×××主任同意目前诊断及治疗”。1.2　主治医…     

主治医师查房考核的做法和体会

医院三级查房是临床最基本、最重要的医疗活动 ,是各级医师进行诊疗工作的一项基本医疗制度 ,也是提高医疗质量的重要保证。查房质量的高低直接影响临床诊治水平。由于主治医师在诊疗质量检控中起承上启下的角色 ,因此对主治医师实施查房考核 ,对加强基础医疗工作 ,提高基础医疗质量具有积极作用。我院从抓主治医师查房入手 ,以此来加强三级查房管理 ,并取得一定成效。1　考核方法及内容对全院临床科室主治医师进行查房考核 ,医院成立了由院长为组长 ,有关职能科室负责人 ,各科主任及老专家组成的考核领导小组 ,按照主治医师查房要求 ,制定…     

抓好主治医师查房是提高医疗质量的关键

主治医师查房是提高医疗质量,保证医疗安全的重要环节.通过调查,发现主治医师查房存在问题主要有：目的 性不强,准备工作不到位,讲述理论与所查病例脱节,基本功不扎实;病情归纳逻辑性不强,结果缺乏综合分析;临床思维较狭窄以及病历审核不严等.针对上述问题,提出应加强教育,提高认识;明确责任;严格示范;执行标准,严格审核;联系实际,学以致用;并重视外语应用能力的培养等.     

坚持业务院长查房 提高医疗质量

业务院长医疗查房是将业务院长在医院医疗质量管理中的主导作用与职能部门检查监督作用有力结合在一起的常见医疗质量管理模式。这种做法能全面了解临床科室业务工作与管理情况,对落实三级医师负责制,突出重点,抓好规范,全面控制医疗质量,培养和考核各级医务人员,进行病案环节质量控制和医疗安全监控等效果显著。     

规范科主任查房的对策

科主任查房是由科主任负责实施、各级医师参加的双向性、实践性诊疗活动。抓好科主任查房,对学科发展甚至医院整体建设具有重要意义。1存在问题1.1查房功能被弱化受市场经济影响,科主任院外活动增加,不能拿出足够、有效的时间做准备;加上工作量大、军队体制编制调整导致医生紧缺等因素影响,科主任查房有逐渐被弱化的趋势。个别科主任只顾自己看病人,既没有病情分析,也没有诊断探讨;还存在只关注影像诊断、不对疾病作全面分析、物理检查不够细致等现象。1.2查房记录质量不高查房记录内容苍白单调,流于形式,常见是“某主任看过病人”,或“某主…     

加强主治医师查房工作的做法与体会

临床医疗工作中主治医师的临床综合能力在整个医疗质量环节中起着重要的作用。该院制定了主治医师查房质量标准，由专家组进行了检查和考核结果的综合评估后，认为医院应加强对主治医师查房质量的管理工作，对查房中存在的各种问题要引起高度重视。特别是要制定严格的主治医师上岗考核标准，上岗后要重视对他们临床实践能力上的培养，并在严格管理及考核的基础上大胆使用，及时发现、帮助其纠正在查房中存在的不足。     

Evaluation of a new course to teach the principles and clinical applications of epidemiology to medical students

A new short course to teach clinical medical students the principles of epidemiology and their applications to clinical practice was introduced at St. Thomas's Hospital Medical School. During the first year one half of the students took the new course. All the students also received the previous epidemiological teaching which was performed on the wards in the context of individual patients with a particular disease. In the next year all students were given only the new course. One year after attending these courses, students completed a questionnaire designed to test how well the course objectives had been met. A comparison was made between those who had received the new course and those who had received only ward round teaching. Students exposed to both the ward rounds and the course were more satisfied with the latter and had a greater appreciation of the importance of epidemiology to clinical practice than students receiving only ward rounds. This improvement was maintained in the subsequent year when the ward rounds were dropped. Students who had the new course also performed relatively better than the others in the Community Medicine multiple choice questions in the Medicine Finals examination, and the marks improved in the subsequent year. This evaluation was also useful in identifying those aspects of the course that need further development.     

An interactional structure of medical activities during acute visits and its implications for patients' participation

Within the context of primary-care, physician-patient visits, researchers have documented both patients' low levels of communicative participation (e.g., question asking) and the advantages of such participation to healthcare (e.g., improved physical health and satisfaction). Prior research has offered a variety of partial, non-exclusive explanations for patients' low levels of participation. This article investigates one underdeveloped source of explanation: the organization of interaction itself. This article argues that the establishment of new medical problems in acute visits makes relevant an organized structure of social action that is composed of an ordered series of medical activities: establishing the reason for the visit, physicians gathering additional information (i.e., history taking and physical examination), physicians delivering diagnoses, and physicians providing treatment recommendations. This "project" of medical activity shapes physicians' and patients' understanding and production of communicative behavior. Using the method of conversation analysis, and analyzing transcribed audio- and videotape data of actual acute visits, this article describes and grounds this project and discusses its implications for research, theory, and improvement on patient participation.     

临床护理查房现状分析

本文归纳了临床护理查房的类型，指出我国目前占主导地位有两种查房，即以问题为基础的护理查房和以护理程序为框架的护理查房。阐述了临床护理查房的目的。介绍了护理查房的形式、人员组成及各级护理查房的时间安排。分析了当前临床护理查房存在的主要问题。指出医院应加强护理查房的管理，做到护理查房有计划、有准备、有标准、有重点，提高护理查房质量。     

The anxieties of new clinical students

The specific anxieties of 74 medical students beginning their clinical training were assessed by means of a questionnaire at the start of the clinical introductory course at St Mary's Hospital Medical School, London. Situations differed in the amount of anxiety that they engendered, and students also differed in the number of situations that they found anxiety producing. Students particularly reported that interactions with senior staff on ward rounds were anxiety provoking. The same questionnaire was also distributed to 52 teaching hospital doctors who were asked to complete the questionnaire as they thought the students had done. Compared with students, the doctors considered more situations to be anxiety provoking, and they differed in their rank ordering of the situations. Doctors tended to overestimate anxiety concerning communication problems, and to underestimate anxiety concerning routine clinical tasks such as phlebotomy.     

Occupational medical prophylaxis for the musculoskeletal system: A function-oriented system for physical examination of the locomotor system in occupational medicine (fokus (C) )

Occupational physicians are very often confronted with questions as to the fitness of the postural and locomotor systems, especially the spinal column. Occupational medical assessment and advice can be required by patients with acute symptoms, at routine check-ups, by persons who have problems doing certain jobs, and for expert medical reports as to the fitness of persons with chronic disorders or after operations. Therefore, for occupational medical purposes a physical examination must aim primarily to investigate functions and not structures or radiologic evidence. The physical examination should be structured systematically and according to regions of the body and, together with a specific (pain) anamnesis should provide a basis for the medical assessment.     

Cardiology patient simulator and computer-assisted instruction technologies in bedside teaching

The design and uses of an innovative technology-based approach which addresses critical problems with bedside teaching during ward rounds in the current health care situation are described. A cardiology patient simulator (HARVEY) and an accompanying computer-based interactive laserdisk system provide medical students, house officers and other health professionals with the opportunity to encounter a wide variety of clinical problems for learning and assessment. A group of cardiologists and medical educators from a consortium of US medical schools has guided the development and formal assessment of the entire system over the past 10 years. The system and simulator can be configured and programmed to provide appropriate heart sounds, laboratory data, and test results upon request; hands-on experience to practise examination skills is also available. The system, whole or in part, can be used in a variety of instructional modes from self-instruction to demonstration teaching, and from self-assessment to the final clinical examination. The system's effectiveness for teaching medical clerks is summarized, as is its use in providing continuing education for primary care doctors in rural practice.     

医学院校体育校本课程开发模式研究

医学院校体育课程不完全同于综合性院校,应结合自身实际,走“体医结合”的特色发展之路。充分利用医学院校的资源,确立多样化培养目标,编制内容丰富课程,创建“体医结合”下体育课程的校本化模式,预防为主的传统养生体育课程模式,健康体检与体质监测紧密结合模式,适时对课程的解释、实施与追踪、评价可永葆校本课程模式新鲜活力。     

日本医院管理方式对我国医院管理的启示

日本在医院管理方面积累了许多成熟的经验,值得我国医院管理者参考、借鉴。通过介绍日本医院的三级医师查房模式,学术预演会制度及医学外语论文抄读会制度,结合我国医院管理的现状,探讨医院查房制度、科研管理的改进措施,以提高我国医务人员的诊疗技术水平、科研能力和外语水平,更好地为广大人民群众提供医疗保健服务。