临沂市放射诊疗资源配置现况调查

目的 了解临沂市放射诊疗资源配置现状,为卫生行政部门进一步优化资源配置提供数据支撑。方法 对全市所有开展放射诊疗的医院进行普查,用SPSS软件对数据进行统计分析。结果 临沂市共有放射诊疗机构305家,放射诊疗设备943台,市民平均每万人拥有放射诊疗设备0.89台,每家机构拥有放射诊疗设备平均数市区是县区的1.48倍。全市共有放射诊疗工作人员2208人,每家医院拥有放射诊疗工作人员7.24人,其中三级、二级、一级和未评级医院拥有放射诊疗工作人员数量分别为89.63、17.64、3.37和2.77名。结论 临沂市放射诊疗设备配置比例失衡,大型放射诊疗设备配置较少且分布集中,每万人拥有放射诊疗工作人员数量不足且分布不均。需科学配置放射诊疗资源,促进地区间的平衡发展,实现资源的优化配置。     

Designing randomised controlled trials in rheumatology – What,why, and how

Randomised controlled trials (RCTs) have become the workhorse for evaluating efficacy of various healthcare interventions. The basic plan is to compare the outcome experience of two or more prognostically similar groups of patients with study intervention being the only difference between them. It involves key elements such as random allocation, concealment of allocation, and blinding to guard against design-related biases. This article explains these key features and the steps involved in designing an RCT in the context of rheumatological diseases.     

公立医院人力资源配置竞争力及问题研究

人力资源配置实际上是用人的艺术,强调人才是一类重要的资源,根据人才的不同能力在不同岗位上进行分配,最大程度发挥人才的价值。当前因为经济水平的不断提升,新医疗体制改革越来越深入,公立医院需要承受非常大的压力。在人力资源配置上,公立医院具有一定竞争力,但同时也存在一些问题,医院必须保持较高的竞争意识,保证人力资源的合理配置,才可以确保医院始终具备良好的竞争力,保证可持续的发展。     

Addressing Geographic Disparities in Liver Transplantation Through Redistricting

Severe geographic disparities exist in liver transplantation; for patients with comparable disease severity, 90‐day transplant rates range from 18% to 86% and death rates range from 14% to 82% across donation service areas (DSAs). Broader sharing has been proposed to resolve geographic inequity; however, we hypothesized that the efficacy of broader sharing depends on the geographic partitions used. To determine the potential impact of redistricting on geographic disparity in disease severity at transplantation, we combined existing DSAs into novel regions using mathematical redistricting optimization. Optimized maps and current maps were evaluated using the Liver Simulated Allocation Model. Primary analysis was based on 6700 deceased donors, 28 063 liver transplant candidates, and 242 727 Model of End‐Stage Liver Disease (MELD) changes in 2010. Fully regional sharing within the current regional map would paradoxically worsen geographic disparity (variance in MELD at transplantation increases from 11.2 to 13.5, p = 0.021), although it would decrease waitlist deaths (from 1368 to 1329, p = 0.002). In contrast, regional sharing within an optimized map would significantly reduce geographic disparity (to 7.0, p = 0.002) while achieving a larger decrease in waitlist deaths (to 1307, p = 0.002). Redistricting optimization, but not broader sharing alone, would reduce geographic disparity in allocation of livers for transplant across the United States.     

Dynamic Challenges Inhibiting Optimal Adoption of Kidney Paired Donation: Findings of a Consensus Conference

While kidney paired donation (KPD) enables the utilization of living donor kidneys from healthy and willing donors incompatible with their intended recipients, the strategy poses complex challenges that have limited its adoption in United States and Canada. A consensus conference was convened March 29–30, 2012 to address the dynamic challenges and complexities of KPD that inhibit optimal implementation. Stakeholders considered donor evaluation and care, histocompatibility testing, allocation algorithms, financing, geographic challenges and implementation strategies with the goal to safely maximize KPD at every transplant center. Best practices, knowledge gaps and research goals were identified and summarized in this document.     

从儿科不同专科病房护理时数测算探讨护理人力资源的合理配置

目的测算儿科不同专科实际所需护士人数，为儿童专科医院及儿科病房护士人力配置提供依据。方法调查浙江省某儿童医院的4个有陪病房（肾脏内科、神经内科、泌尿外科及烫伤、骨科病房），采用观察法测量各病房直接护理时间、间接护理时间，然后采用工时测定法计算出儿科不同专科病房每个患者每日所需护理时间。根据公式计算出不同专科所需护士人数，并对数据进行分析。结果儿科不同专科病房每日直接护理时间和每日所需护理时间比较差异有统计学意义，间接护理时间各病房间比较差异无统计学意义。病床与护士之比以神经内科最高1：0．70，其他依次为烫伤、骨科病房1：0．60、泌尿外科1：0．58、肾脏内科1：0．57。结论儿科不同专科病房所需护士人数存在明显差异，应根据专科不同来配置护士人力。     

卫生资源优先次序分配的政府治理研究——国际研究述评及对我国的启示

卫生资源优先次序分配作为政府有效治理的重要领域,在我国仍缺乏类似层面的综合思考。西方在该领域的研究趋势已从单纯的经济学思考走向了政治经济学、制度约束、卫生筹资的全面分析,并在更宏大的组织和政治情境中,考量政府的治理范围、手段,建构操作性强的优先次序分配框架。在卫生决策实践中,找寻跨学科工具的最佳组合考验着决策者的治理水平。本文梳理政治学、卫生经济学、哲学、法学、循证医学等不同学科对卫生资源优先次序分配的思考。最后明确政府卫生资源治理的层次、治理策略建议,强调卫生决策从＂作为结构的治理＂走向＂作为过程的治理＂的发展规律因应我国所面临的挑战。     

Retrospective Analyses for Hypothesis Generation A Commentary on the Pack Trial (Prevention of Atherosclerotic Complications with Ketanserin)

Publication of the results of a large-scale randomized control trial (RCT) of the anti-serotonin drug ketanserin in patients with intermittent claudication offers an opportunity to examine the validity of retrospective subgroup analyses to generate hypotheses for further validation. This was prompted by an unanticipated adverse interaction which occurred in a subgroup of patients receiving both ketanserin and potassium-losing diuretics. The quality of the study ranked it in the 99th percentile of over 400 RCTs evaluated by a quality scoring system. The subgroup analysis resulted from the emergence during the study of a highly significant excess mortality in the patients on diuretics (relative risks 0.88 for those on ketanserin alone, 0.95 on potassium-sparing and 2.44 for those on potassium-losing diuretics (P = 0.007). External validity was evident from data in the literature indicating that a rare tendency of the many drugs that prolong the QT interval to cause torsade de pointes and fatal arrhythmias is exacerbated by hypokalemia of the degree caused by potassium losing diuretics. When the keganserin and-placebo treated Ratients also on potassium-losing diuretics are removed from the analyses there is a 23% reduction iri endpoints which the power is no longer sufficient to detect as significant. There is also an apparent lag phase. Further study of the drug is clearly indicated.     

地区和县级疾病预防控制机构免疫规划工作人力配置现状和需要研究

目的测算全国地区和县级疾病预防控制机构免疫规划人力配置情况,为疾病预防控制体系建设提供依据。方法运用科学管理原理和标杆管理思想,确定目标群体,根据设定的公式,按照免疫规划工作规范模拟运作结果的人时数进行测算,推算模拟运作全国地区和县级疾病预防控制机构人力配置,并与回顾性调查实际值和理想值进行比较。结果按模拟运作结果测算,地区级疾病预防控制机构免疫规划工作人员缺位2.67%,县级疾病预防控制机构超额17.69%;按照理想人力结果测算,地区级疾病预防控制机构缺位25.69%,县级疾病预防控制机构缺位20.66%。结论目前的人力资源基本满足需要,距理想化状态人力资源仍差20.66%~25.69%。当前的重点是提高在岗人员素质,以提高工作质量。     

上海市护理人力资源配置现状伦理分析

通过调查收集上海市34所各级医院护理人员现状，反映目前上海市护理人力资源配置的基本情况。调查结果经统计学处理显示，目前上海市护理人员配置数量不足，学历、职称结构偏低，年龄结构较轻，以女性护士为主。通过对护士配置现状的公平性、服务的可及性和结构合理性的分析，为政府部门提出建议。