基于DRGs的医疗服务绩效差异分析:以二级综合医院为例

目的对成都市二级民营综合医院与公立综合医院住院医疗服务绩效进行DRGs分析和比较,找出差异,提出建议。方法收集2019年成都市二级民营综合医院和二级公立综合医院住院病案首页数据,利用四川省DRGs应用平台进行分组计算,使用SPSS 20.0软件进行指标分析。结果成都市二级民营综合医院与二级公立综合医院2019年住院医疗服务绩效在医疗服务（总权重、覆盖DRGs组数和CMI值）、医疗效率（时间消耗指数、费用消耗指数）上并无显著差异,但在医疗质量与安全（中低风险及以下组病死率、标化病死率）上差异明显。结论二级民营综合医院与二级公立综合医院整体医疗服务差距逐渐缩小;二级民营综合医院内部发展不均衡,医疗质量与安全水平低于二级公立综合医院。建议持续提升民营综合医院服务能力,加强民营综合医院医疗质量与安全管理,同时政府须对民营医院强化监管。     

公立医院优势学科病种绩效管理研究:以骨科为例

目的从循证视角建立公立医院优势学科病种绩效管理工具。方法以波士顿矩阵理论为指导,以“病种均次毛利率、病种均次住院日”为主要指标,“日均毛利率”为辅助指标,采用Microsoft office EXCEL 365 软件进行分析。结果2019年骨科平均住院日为4.99 d,均次平均毛利率为23.62%,日均毛利率平均值为4.73%。骨科200例以上病种、不同亚专科病区病种、同一亚专科病区内不同病种、不同亚专科病区相同病种,绩效均存在差异。结论 管理者应对不同病种绩效指标进行适当校正,探索精细化病种诊疗与管理模式。     

肥胖者与非肥胖者24小时动态血压对比观察

目的：比较肥胖者和非肥胖者24h动态血压变化与高血压检出率。方法：采用24h动态血压监测技术,对肥胖者和非肥胖者24h平均收缩压和平均舒张压,白昼与夜间平均收缩压和平均舒张压,血压负荷,平均心率,24h血压波动趋势进行对比观察,结果：肥胖者各项血压指标及平均心率均较非肥胖者有明显升高（P＜0．05或P＜0．01）。结论：肥胖者高血压检出率明显高于非肥胖者,动态血压监测技术对肥胖者血压的评估有一定临床意义。     

Effects of combined whole body vibration and resistance training on lower quadrants electromyographic activity,muscle strength and power in athletes

BackgroundWhole body vibration (WBV) with resistance training is one of the increasing ways of gaining ankle and foot complex muscle strength and power for the rehabilitative and prophylactic purpose in athletes.ObjectiveThe purpose of the study was to compare the effects of combined WBV and resistance training (RVE) with strength training alone (RE) on alteration of gastrocnemius lateralis and vastus medialis obliquus muscle activity and strength, and power performance in athletes.MethodsThe study was performed on 23 university-level male athletes who were randomized into two groups as RVE (n = 12; age 22.2 ± 1.94 years) and RE (n = 11; age 21.60 ± 1.78 years). The training program was scheduled three times per week for six weeks (18 sessions). Gastrocnemius lateralis (GL) and vastus medialis obliquus (VMO) were measured for muscle activity and isometric strength with surface EMG device and handheld dynamometer respectively. Counter-movement jump (CMJ) was used for measuring power. All the participants were assessed for outcome measures at baseline and then after 6 weeks. Group (RVE vs. RE) by time (pre vs. post) effects were compared through a 2-way interaction utilizing mixed model repeated measure ANOVA.ResultsAfter training, VMO muscle activity (group effects) increased significantly in the RVE group (p < 0.05). However, both the groups showed statistically significant time and group × time interaction effects for muscle activity of VMO, isometric strength (VMO and GL), and CMJ (p < 0.05).ConclusionWBV might serve as an adjunct modality for enhancement of the neuromuscular activity of the VMO muscle. However, RVE had no additive effect when compared to RE alone on muscle strength and power in athletes. The long-term impacts of combined WBV and resistance training on other foot and ankles muscle should be investigated in future studies.     

Caffeine and nicotine improve visual tracking by rats: a comparison with amphetamine,cocaine and apomorphine

Psychomotor stimulant drugs such as caffeine, nicotine, amphetamine and cocaine, have been shown to improve vigilance in man under conditions of fatigue. Nicotine has also been shown to improve performance in some cognitive tests in patients with Alzheimer's disease. In rodents these drugs increase activity which may confound performance enhancing effects in rodent models. However, improvements have been found in a number of tests that do not seem to be directly dependent upon an enhancement of locomotor activation. In one example, Evenden and Robbins (1985) reported consistent improvements in a visual tracking test following amphetamine. The present study was undertaken to determine whether these performance enhancing effects of amphetamine could also be obtained with cocaine and apomorphine, which both have psychomotor stimulant effects through their actions as, respectively, indirect and direct dopamine agonists, and by caffeine and nicotine, which do not have a direct dopaminergic mechanism of action. The results of the study indicate that all five drugs improved tracking performance at one or more doses. The most consistent effects were obtained with amphetamine which, like cocaine and nicotine, improved tracking at a dose which did not produce other changes in behaviour. Taking into account previous studies (Evenden and Robbins 1983, 1985), these results were interpreted as indicating that psychomotor stimulant drugs produce ageneral activation of behaviour. At all but the highest doses of such drugs, the form of behaviour that is observed depends upon the environment. The results of this study support the conclusion that in the situation where stimuli are present which exert a strong control over behaviour in the undrugged state, then the stimulated behaviour will be directed towards those, and may result in an enhancement of performance.     

Prediction of physical activity level in adulthood by physical characteristics,physical performance and physical activity in adolescence: an 11-year follow-up study

The purpose of the study was to investigate to what extent the physical activity pattern in adulthood can be predicted by physical characteristics, performance and activity in adolescence. A group of 62 men and 43 women completed a questionnaire concerning physical activity during their leisure time at the ages of 16 and 27 years. An activity index produced from the questionnaire. At the age of 16 years, the subjects were also tested for strength (strength test battery) and running performance (9-min run). Maximal oxygen uptake ( ) was estimated from a submaximal test and a muscle biopsy specimen was taken and analysed for fibre types (percentages of types I, IIA, 1113). The proportion of subjects engaged in some kind of physical activity during their leisure time was approximately 70% among the women and 80% among the men at both ages. The time spent on physical activity (minutes per week) decreased with age for the men but not for the women. The women devoted less time. to physical activity than the men both at age 16 and 27 years. The attitude to endurance activities had changed to a more positive attitude among the women and to a less positive attitude among the men at age 27 years. The aerobic potential ( and percentage of type I fibre), running performance, strength performance, physical activity and marks in physical education at age 16 years explained 82% of the physical activity level in adulthood for the women and 47% for the men. The aerobic potential at age 16 years alone explained 31% of the adult physical activity level in the women and 24% in the men. Strength performance, physical activity and marks in physical education at age 16 years further increased the predictive value for the physical activity level in adulthood for the women but not for the men. It is suggested that the major portion of the variation in physical activity level in adult women, but not in the adult men, could be predicted from physical characteristics, physical performance, and the activity level in adolescence.     

Error-related processing during a period of extended wakefulness

The nature of error detection as manifested by the error-related negativity was examined in both a Sternberg memory search task and a visual search task. Both tasks were performed in conditions with consistent or varied stimulus-response mapping and loads of three or six letters. After subjects were trained extensively in all conditions, they performed the tasks throughout the night without sleeping. The data suggest that the effectiveness of error detection decreases over time because of a decrease in the quality of perceptual processing. Error detection also suffers when performance requires more search-related resources. In both cases, the representation of the correct response is compromised. These results indicate that error detection depends on the same perceptual and cognitive processes that are required for correct performance.     

妇幼保健机构二级评审中实现护理指标的探讨

妇幼保健机构等级评审细则对护理管理有明确的管理目标和量化指标。广州市妇幼保健院在二级妇幼保健机构等级评审工作中,护理管理确立以质量管理为核心,使护理管理工作制度化、质量管理标准化、质量控制数据化、技术操作规范化、病区设置规格化和日常工作程序化。按评审细则要求评价护理部在实施目标管理中对护理管理、院内感染管理和爱婴医院工作的管理能力和业务水平,注重考察护理人员的整体素质和操作技能,使护理工作趋向标准化、规范化和科学化管理。