医院理念文化谈

理念文化是医院文化的核心和灵魂。根据医院所处地域、内外环境、服务性质和管理传统的不同，医院的理念文化都具有自己的个性和特色。本文就基层精神病医院的特点阐述了医院理念文化。内容包括（1）学习理念：学习是社会发展的需要；学习要实现三个转变；学习能力是竞争制胜的法宝。（2）人才理念：人才的概念；用才的学问；要不断培养人才。（3）管理理念：要知人善任；要以情感人。（4）团队理念：合作意识、团队意识、团结精神。（5）安全理念：安全就是效益，知识和技能是基础，心态和责任心是关键，制度是保障。     

家庭病房的现状分析与未来展望

随着医学模式的转变，社会的发展，人们对健康要求的提高，医疗保健工作必须从以前的“以医院为中心”向“以患者为中心”的指导思想转变。未来医院必将向以下10个方面发展：（1）分工精细与多种综合的新型医疗技术结构日益形成；（2）广泛应用现代科学技术的成就，是现代医院发展的一个显著特点；（3）培养一支掌握现代科学技术的专业队伍；（4）医疗设备先进、医院建筑现代化；（5）医院管理科学化、系统化、信息化；（6）医院从医疗型逐步向医疗、     

深化医院运行机制改革的做法与成效

为了达到以病人为中心、以质量为核心、以医生为轴心、通过以病人选择医生为契机，启动了深化医院运行机制改革。一是以人本管理创造良好的竞争氛围；二是以人本管理促进病人选择医生健康发展；三是以人本管理对医生实行滚动竞争激励，从而取得了很好成效。（1）2001年1－6月较2000年1－6月，门诊人次增加30042人次，出院增加1275人次，每百元医疗收入消耗卫生下降5．28％等。（2）解决了医院管理中长期存在但又未能解决的弊端。如高职低聘、老中青之间的关系、管理误区等。（3）医院内部形成了有活力的运行机制。     

医院人才综合管理新探讨

医院的竞争在于人才竞争，医院良好的管理是充分发挥医院优秀人才的摇篮。通过人才合理培养，充分调动医护人员的积极性，才能促进医院的发展。     

深化改革是企业医院发展的必由之路

结合医院实际，介绍了医院改革的主要做法及效果。主要做法：（１）对人员机构进行改革；（２）对干部人事制度进行改革；（３）对医院的管理体制进行改革；（４）对经济管理及分配方式进行改革；（５）实行一院两制，联合办院。效果：（１）职工的思想观念有了很大的转变；（２）成功地实现了人员分流；（３）增收节支成效显著；（４）经济效益明显提高，社会效益日益显现。     

医疗改革面临的深层次问题及对策

山东省卫生厅于１９９７年１２月组织了对部分市地卫生行政部门和医疗机构的调研，对医疗机构的管理体制，内部运行机制和补偿机制进行了分析，医院改革面积的深层次问题主要有：（１）医疗机构管理体制上管人权与管事权相分离；（２）改革意识和思想观念有待进一步转变；（３）卫生行政部门需加强对医院的依法管理；（４）医院的内部改革有待深化；（５）医院管理水平有待进一步提高。提出了进一步解放思想，加强对医院工作的指导，     

新世纪医院面临的挑战与对策

作者首先阐述了新世纪医院面临的挑战：一是社会保障制度改革对医院的影响；二是中国加入WTO后对我国医院产生的影响；三是人们需求多样性对医院建设的影响。其次提出了新世纪医院的发展策略；（1）树立新的理念；（2）强化四个意识，即管理意识、竞争意识、服务意识、创新意识；（3）医院建设要注重系统性，即以市场和战场为导向调整学科布局，适应市场需求抓好人才队伍建设，以新的质量观抓医疗质量建设；（4）建立灵活高效的管理机制，即建立快速高效的决策程序、建立以人为本的管理机制、以市场经济的规则改革分配机制，政府对非营利性医院要解决资金补偿问题。     

现代医院管理人才素质结构探讨

人才是医院发展的关键，而素质结构建设则是医院管理人才作用得以充分发挥的前提。笔者运用耗散结构理论分析目前医院管理人才素质结构。（一）素质结构现状：１．知识构成单一：目前许多管理干部，缺乏管理学、经济学、心理学等必备知识。２．内外封闭僵化：在我国，由于...     

医院核心人才管理初探

新形势下，医疗市场的竞争越来越激烈，竞争的实质是医院间核心竞争力的竞争，说到底是人才竞争。医院人才中最关键的是核心人才，他们是医院核心竞争力的主要体现。核心人才的流失对医院核心竞争力的影响是巨大的，如何做好对核心人才的管理以防止其流失，是新时期人力资源管理的重要课题。     

浅谈医院科研管理工作中风个误区

医院科研管理工作是一个科学性很强的工作，广大科研管理者应避免一些误区；（1）注重医疗工作而忽视科研工作；（2）注重外来科研人才的引进而忽略本地科研人才的培养；（3）注重院外课题而忽略院内课题；（4）一般课题和重点课题并重；（5）强调课题的数量而忽略的质量；（6）强调精神奖励而忽略物质奖励，或强调物质奖励而忽略精神奖励；（7）注重课题的前，后期管理而忽略课题的中期管理；（8）轻视科研信息在科研工作中的作用。     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.     

Psychopathological features of a patient population of targets of workplace bullying

BACKGROUND: A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems. AIMS: To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features. METHODS: Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study). RESULTS: At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. CONCLUSION: Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.     

The rise and fall in incidence of malignant mesothelioma from a British Naval Dockyard, 1979-1999

BACKGROUND: The incidence of malignant mesothelioma in Britain is predicted to rise over the next 15-25 years because of past failure to protect the workforce against inhalation of asbestos. In British Naval dockyards, alternative insulation materials and respiratory protection were introduced from the mid-1960s. Aims This study was carried out to investigate the effects of these control measures on mesothelioma deaths in dockyard workers. METHODS: Cases of mesothelioma of the pleura and peritoneum between 1979 and 1999 in workers from the Devonport Naval Dockyard, south-west England, were sought from coroners' and medico-legal records. RESULTS: Three hundred and one cases were identified, 7% peritoneal. The peak incidence occurred in 1991 with 25 cases per annum (quadratic model fit R(2) = 74.2%, P < 0.001) and we predict that by 2003 the incidence will fall to fewer than five cases per annum. The mean time between first exposure and presentation was 48.5 years [95% confidence interval (CI) = 47.3-49.8], but this was significantly shorter in the more heavily exposed trades, when compared with the less heavily exposed (42 years, 95% CI = 39.0-45.0, versus 49.5 years, 95% CI = 48.2-50.9). Those with higher exposure were also at significantly greater risk of peritoneal disease (P < 0.023, Fisher's exact test). CONCLUSION: The reduction in incidence of mesothelioma is greater than can be accounted for by reduction in numbers of dockyard workers over the last 50 years. Changes in insulation materials and improved industrial hygiene measures introduced into the Devonport Dockyard from the mid-1960s have resulted in an earlier decline in the incidence of malignant mesothelioma than that predicted for the British workforce as a whole.     

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.     

Organophosphate toxicity and occupational exposure

The ubiquitous organophosphates present a continuing health hazard in agriculture, public health eradication programmes and as chemical warfare agents. Despite significant progress in understanding the potential mechanisms of toxicity far beyond the commonly accepted mechanism of cholinesterase inhibition in intentional exposures, the precise health effects following occupational exposures are yet to be completely defined. A much greater understanding exists of the clinical features of organophosphate poisoning. These are characterized by a triphasic response involving an initial acute cholinergic phase, an intermediate syndrome (both associated with high mortality) and a disabling but non-lethal delayed polyneuropathy. The delayed polyneuropathy may occur in the absence of the cholinergic or intermediate phases. However, progress is still required in order to improve the quantification and assessment of occupational exposures and the implementation of appropriate preventive measures. Finally, evidence-based guidelines for appropriate or optimal therapeutic interventions following poisoning are required urgently and collaborative work with colleagues in developing countries, where the occurrence of organophosphate exposures is more frequent, may provide the answers.     

Miliaria rubra of the lower limbs in underground miners

This report documents a case series of miliaria rubra of the lower limbs in miners at a deep underground metalliferous mine in tropical arid Australia. During the summer months of February and March 1999, all cases of miliaria rubra of the lower limbs in underground miners seen at the mine's medical centre were clinically examined and administered a questionnaire. Twenty-five patients were seen, an incidence of 56.4 cases per million man-hours. Miliaria rubra was most often located between the ankle and knee (88% of cases). Twenty-four percent had concurrent folliculitis and 20% had concurrent tinea. Thirty-two percent had a personal history of asthma. Walking through ground-water and splashing of the legs was common. Three to 4 weeks of sedentary duties in air conditioning was generally required to achieve resolution of miliaria rubra. The incidence of miliaria rubra of the lower limbs is 38% of the incidence of heat exhaustion at the same mine. The length of disablement is greater, however. Atopics may be at increased risk of miliaria rubra. Control measures are discussed.     

Planning research

The starting point for any research project should be a question.Once this has been defined and the relevant scientific literaturereviewed, a protocol should be drawn up. This will be used notonly as a guide to the conduct of the study and in the preparationof the final report, but also in seeking any financial supportand approvals that are required for the investigation. A protocolis normally arranged in sections covering the background tothe study, the question(s) that it will address, the methodsthat will be used for the collection and analysis of data, thestatistical power of the investigation (where relevant), anyethical considerations, and the financial input that will beneeded. A pilot study is often helpful where aspects of thestudy method are untried or of uncertainvalidity.