物流学原理在药房调剂工作中的应用与体会

目的:提高医院药房调剂工作的质量、效率和管理水平。方法:依照物流学原理,统筹发药路径,减少无效的药物搬运,实施流程设计,合理利用机械。结果与结论:依照物流学原理改进药房调剂工作,能使调剂工作的质量和效率得到提高,管理得到加强,员工劳动强度下降。     

Efficiency and administrative costs in primary care

We use a formal model to examine the implications of endogenous managerial effort for the interpretation and estimation of efficiency in health care organisations. The model is applied to investigate the doubling of the cost of administering primary care in England in real terms between 1989/1990 and 1994/1995. The main cost determinant was the number of general practitioners (GPs), and there were economies of scale but not of scope. Fund-holding had a positive but small effect on administrative costs, so that the recent abolition of fund-holding may do little to reduce primary care administrative costs. After allowing for changes in the numbers of primary care practitioners, the quality of primary care and the extent of fund-holding, most of the increase in costs was unexplained, and may reflect additional but unmeasured increases in the administrative burden associated with the 1990 reforms. There was little variation in relative efficiency across areas.     

Effects of paclitaxel, docetaxel and their combinations on subcutaneous lymphomas in inbred Sprague–Dawley/Cub rats

We investigated, whether the effects on paclitaxel, docetaxel or their combinations on T-cell lymphomas in Sprague-Dawley/Cub rats were mainly caused by their different efficiency or combination of different mechanism of action, or limited by metabolic inactivation by P450 enzymes or drug efflux caused by P-glycoprotein (P-gp). Docetaxel most effectively prolonged the survival of rats and the time of lymphoma appearance, inhibited their intravital size and weight after sacrifice. Paclitaxel was poorly effective and combined administration had intermediate effects. Blood levels of both drugs were similar. Repeated administration of paclitaxel, but not docetaxel, decreased its area under concentration, but the effect disappeared 6h after dosing and was not sufficient to explain lower effects of paclitaxel. The faster metabolism of docetaxel than paclitaxel in vitro did not limit its higher efficiency and repeated administration of paclitaxel did not induce its metabolism to decrease its blood levels sufficiently. Likewise, undetectable expression of P-gp protein in tumours could not explain lower effects of paclitaxel, which is a better substrate of P-gp. Docetaxel was three-fold more effective than paclitaxel against P388D1 lymphoma cell line, used as a model of the T-cell lymphoma and combined action was dominated by the effects of docetaxel. Thus, docetaxel was effective against T-cell lymphomas and may be a potential anticancer drug in similar indications.     

徐州地区教师职业倦怠状况的调查研究

目的了解教师职业倦怠的状况，为教师心理卫生提供基础研究。方法采用自行设计的教师职业倦怠问卷对167份来自徐州地区的教师进行自我效能感、情绪倦怠、去个性化三个维度的调查。结果数据显示43％的教师存在着职业倦怠。贮检验结果表明各类教师的职业倦怠程度的差异有显著意义，中小学教师较幼儿园教师更为严重，此外城乡差异有显著意义。结论教师群体职业倦怠状况不容乐观。     

数据包络分析在乡镇卫生院效率评价中的应用

目的恰当应用数据包络分析(DEA)方法评价乡镇卫生院的效率，为乡镇卫生院效率评价提供方法学依据。方法用服务当量法和专家咨询法设计了乡镇卫生院医疗防保服务产出的综合指标，并用DEA法计算出乡镇卫生院的相对效率得分。结果DEA有效单元有9个，占全部单元的5．4％，乡镇卫生院各年的DEA得分呈下降趋势。结论①本研究通过研制乡镇卫生院服务产出综合指标，在DEA产出指标体系中包含了防保和医疗服务的更多产出信息，更加综合地反映了乡镇卫生院的效率。②乡镇卫生院的整体效率较低，且呈逐年下降趋势。     

医疗行业政府管制的改进

医疗行业具有政府公共产业的属性及市场属性，且存在着政府和医疗机构之间以及医患之间的信息不对称，单纯依靠市场机制无法健康发展，因此需要引入政府管制。作者通过介绍政府管制的内涵及发展历史，分析了我国医疗行业政府管制的状况，提出引入激励性管制，建立并完善医疗收费体系、医疗质量评估体系和医疗法律体系，才能保证有效控制医疗成本，兼顾医疗的公平和有效，使医疗行业高效、公平、有序地发展。     

亚胺培南/西司他丁对重症肺炎的降阶梯治疗疗效分析

目的观察亚胺培南/西司他丁(TPM)对重症肺炎降阶梯治疗的疗效.方法将急诊入住ICU的32例重症肺炎分为两组:一组入院前静脉未给予抗菌药物(未治疗组,15例);另一组入院前曾静脉应用抗菌药物但无效者(已治疗组,17例),入院后均接受静脉用亚胺培南/西司他丁治疗,观察疗效及转归.结果两组在年龄、治疗前合并心、肾等脏器功能不全和呼吸机依赖等病理特征差异无明显性(P＞0.05),但未治疗组发病时间较短、呼吸衰竭程度更严重(P＜0.05);接受亚胺培南/西司他丁治疗后,未治疗组所需机械通气时间和住ICU时间比已治疗组明显缩短(P＜0.05);未治疗组的总有效率为80%,已治疗组为47%(P＜0.05).结论经验性治疗将亚胺培南/西司他丁作为重症肺炎起始用药,可防止病情迅速恶化,随后根据病原学及临床效果换用针对性抗菌药物的降阶梯疗法有其合理性.     

Über Wirksamkeit,Dosisrelation und Depoteffekt eines synthetischen Polypeptids mit ACTH-Wirkung

Zusammenfassung In der vorliegenden Untersuchung werden die Wirksamkeit, die Dosisrelation und der Depoteffekt eines synthetischen depot-^1–24-tetracosactide (Cortrophine-S-Deport Organon^®) und eines nach herkömmlicher Weise hergestellten Depot-ACTH-Präparates (Cortrophine-Z Organon^®) verglichen. Als Parameter gilt die Ausscheidung des freien Cortisols im Harn. Bei einer angenommenen Relation von 100 IE Cortrophine-Z gleich 1 mg Cortrosyn-Depot zeigt das synthetische Präparat bei vollwertiger adrenocorticotroper Wirkung einen Gesamtstimulationseffekt von 70,2% desjenigen des herkömmlichen Präparates. Dabei ist der Initialphaseneffekt bei beiden Präparaten gleich. In der sogenannten Stimulationserhaltungsphase und in der Abklingphase des Depoteffektes zeigen sich Unterschiede zugunsten des herkömmlichen Präparates. Es errechnet sich eine Dosisrelation von 100 IE Cortrophine-Z gleich 1,42 mg Cortrosyn-Depot, wobei diskutiert wird, ob es sich hier in der Tat um ein Dosisproblem oder um ein Problem der Depotstabilität handelt.

---

Efficiency, dose relation and depot effect of a depot-^1–24-tetracosactide

This paper reports on a comparative study on a synthetic depot-^1–24-tetracosactide (Cortrophine-S-Depot Organon^®) and an extractive ACTH-depotpreparation (Cortrophine-Z Organon^®); the factors studied were efficiency, dose relation, and depot effect. The parameter used was the excretion of free cortisol in the urine. Assuming a dose relation of 100 I.U. of extractive ACTH equal to 1 mg of the synthetic preparation, our results show, that the synthetic preparation evokes a stimulative effect which equals 70.2% of that of the extractive ACTH. The difference was especially observed in the decreasing phase of the depot effect. The true dose relation calculated with regard to the parameter used, was 100 I.U. extractive ACTH to 1.42 mg of the synthetic tetracosactide. However, it has to be considered whether the difference between the two preparations regarding the effect of stimulation is in fact a question of unequal doses or a question of the stability of the depot itself.

Die Untersuchung wurde im Rahmen einer Beihilfe der Deutschen Forschungsgemeinschaft, Bad Godesberg, durchgeführt (Sto 45/8)     

Cognitive Efficiency in Alcoholics and Polysubstance Abusers

Previous studies have found alcoholics to be impaired on tests of cognitive efficiency. However, it is unclear to what extent individuals who abuse drugs in addition to alcohol exhibit similar deficits. To answer this question, 63 healthy control subjects were compared with 40 individuals who abused alcohol only, 24 individuals who abused alcohol and stimulants, 16 individuals who abused alcohol and marijuana, and 41 individuals who abused alcohol and depres-sants/narcotics, or alcohol and two or more other drugs. All subjects were administered tests of Short-term memory, spatial orientation, visual-spatial perception, and problem-solving. Results from the study indicated that control subjects and individuals who abused both alcohol and marijuana performed significantly better than the other groups on most tests. These results were not attributable to differences on measures of affect or chronicity of alcohol consumption.     

Adequacy and efficiency of nursing staff in a child-welfare-clinic at Umtata General Hospital, South Africa

Background

South Africa has a serious shortage of human and financial resources to provide primary healthcare services especially in the historically under-served areas. It is a tedious task to carry out healthcare delivery for the masses without rationalizing human resources in the form of re-allocation and re-deployment of healthcare personnel. This study aimed to establish the level of adequacy and efficiency of nursing staff in the former Transkei region. The study was carried out in the child and family welfare clinic of the Umtata General Hospital.

Objective

To assess adequacy and efficiency of nursing staff in a child welfare clinic.

Method

This was a retrospective study. The workload of two nurses allocated to the child welfare clinic at Umtata General Hospital South Africa was calculated based on the patient numbers and hours of work per week. Calculations excluded time breaks for tea, lunch and annual leave. This work load was compared to the norms of standard examination time that is 12 minutes per patient obtained from the sub directorate of Natalia Office of the Department of Health. Information regarding number of patients attended to by the nurses and their disease conditions was obtained from retrospective review of hospital records.

Results

While each nurse was on duty for 8 hours per day each had only 6 reproductive hours. The two nurses examined only 310 patients giving staff utilization of 2.46% (i.e. 310/12600) and adequacy of staff of 0.0492 or 310/6300.

Conclusion

There is under-utilization of the staff in Umtata General Hospital, South Africa.

Recommendation

To increase utilization of the nurses a process of sharing and merging with a clinic or a ward with similar type of work is recommended.