美国医院如何控制细菌对抗菌药物的耐药性?

“如何控制细菌对抗菌药物的耐药性”在关国医院内是一个热门话题,医生们基于临床经验所建立的一些临床治疗“指南”,其中之一是合理和正确指导使用抗菌药物。为此,对该“指南”中关国医院对抗菌药物的使用现状（主要以上呼吸道疾病为例）和成人合理使用抗菌药物的指导原则,以及合理和正确使用抗茵药物的处方指南作一介绍。     

Assessing Community-Based Injury Prevention Services in U.S. Children's Hospitals

ObjectiveNot-for-profit hospitals are required to meet federal reporting requirements detailing their community benefit activities, which support their tax-exempt status. Children''s hospitals have long provided community injury prevention (IP) programming and thus can inform public health outreach work in other areas. This work describes IP programming as a community service offered by children''s hospitals in the U.S.MethodsThe IP specialist at 232 US-based member institutions of the Children''s Hospital Association were invited to complete an assessment of their hospital''s IP outreach programming.Results47.7 percent of hospitals request financial data from IP programming for tax reporting purposes. Almost all offer injury prevention (IP) services; the majority are in the community (60.3%) and 34.5% are hospital-based. Most IP units are independent (60.3%) and 71.8% are responsible for their own budgets.ConclusionsBy integrating dissemination and implementation sciences and community health needs assessments, these findings can help advance community services provided by hospitals to impact public health.     

黑龙江省县级公立医院员工薪酬满意度分析

目的：调查县级公立医院医务人员薪酬满意度水平,为相关政策设计及效果评价提供参考。方法：对8家县级公立医院员工进行现场问卷调查,利用SPSS19.0统计软件进行统计描述与logistic回归分析。结果：调查对象的薪酬总体满意度平均得分54.05±18.04分;福利方面的满意度最低,平均得分7.98±3.51分;logistic回归分析发现学历、科室类别、每周工作时间、周围同事是否存在收红包现象和是否在编是薪酬总体满意度的影响因素。结论：县级公立医院员工薪酬总体满意度水平不高;对福利方面的满意度水平最低。建立合理的薪酬水平、薪酬提升、福利保障等机制是提高县级公立医院医务人员薪酬总体满意度的可行选择。     

北京二级医院与社区医院2009-2012年药品销售情况比较分析

目的:研究2009-2012年北京市基层医疗机构的用药状况和趋势。方法:对参与"北京基层医疗机构药物利用评价及用药合理性监测研究"的14家二级医院和51家社区医院药品销售情况进行统计,对其2009-2012年药品销售情况进行比较、分析。按年度和季度、中西药分类、药品分类、药品生产企业分类分别统计药品销售金额。结果与结论:不论是二级医院还是社区医院,药品销售金额均稳步增长,并且社区医院销售金额增长幅度明显高于二级医院。二级医院主要使用的药品类别是抗菌药物、心血管系统药物、血液和造血器官用药、消化道和代谢药物;而社区医院主要使用的药品类别是心血管系统药物、消化道和代谢药物、抗菌药物。不同级别医院内、外资企业药品销售金额比例不同,外资企业药品销售金额比例由高到底依次为三级医院(53%⁵4%)、社区医院(26%54%)、社区医院(26%³2%)、二级医院(16%32%)、二级医院(16%²0%)。     

9家肿瘤专科医院2012年抗菌药物用药分析

目的:调查肿瘤专科医院抗菌药物的使用情况,为促进临床合理用药提供有用信息。方法:统计分析2012年中国药学会医院药学专业委员会《医院处方分析合作项目》肿瘤专科项目组随机抽取的全国6个地区9家三级甲等肿瘤专科医院的抗菌药物处方及住院医嘱。结果与结论:9家肿瘤专科医院的抗菌药物数据显示,用药金额居前5位的药物种类为头孢菌素类、碳青霉烯类、青霉素类(含酶抑制剂)、喹诺酮类、三唑类等;住院患者用药金额占较大比例,最低的为61.6%,最高的为98.8%;用药频度居前5位的药品有阿莫西林、阿奇霉素、莫西沙星、头孢呋辛、头孢克洛等。随着抗菌药物临床应用专项整治活动的推进,肿瘤专科医院加强了抗菌药物品种品规的管理;某些抗菌药物的用法用量仍存在不合理现象。肿瘤专科医院应持续加强临床抗菌药物的管理及合理使用。     

昆明市二级以上公立医院基本药物配备使用情况调研简

目的调研昆明市二级以上公立医院在实施基本药物制度以来医院配备和使用基本药物情况,揭示医院用药结构的变化。方法采集昆明市8家二级以上医院2009年至2011年药品采购数据,并进行统计和分析。结果与结论无论是基本药物的采购金额,还是基本药物品种数占采购总金额及总品种数和目录品种数比例变化均不大,虽然云南增补化学和生物制品品种数比例逐年增加,但其采购金额占总金额的比例并未增加（P〉0．05）。昆明市基本药物使用量和覆盖率有待提高。     

Psychiatric nursing staffs’ attitudes towards the use of containment methods in psychiatric inpatient care: An integrative review

One of the international objectives in psychiatric care is reducing the use of coercion. Containment methods are meant to keep patients safe, yet usually include coercion. Nurses play a key role in deciding whether or not containment should be used and, as such, their attitudes towards containment can significantly impact the extent to which these methods are applied. The aim of this integrative review was to identify, analyse, and synthesize the available research on psychiatric nursing staffs’ attitudes towards containment methods in inpatient psychiatric care. An electronic search was conducted using the CINAHL, Scopus, and PsycINFO databases. In addition, the citations of identified studies were screened for relevant research. A total of 24 relevant papers published between 2002 and 2017 were selected for further analysis. These studies revealed variation in nursing staffs’ attitudes towards the use of containment methods. The use of containment methods seems to be widely accepted and nurses reported rarely considering alternative measures. It appears that attitudes towards containment have continuously become more negative, although the change has not been very pronounced. The concept of attitude was only defined in two studies. Thus, future research should strive to clarify this concept, as a generally accepted definition for attitude within nursing research and the utilization of all dimensions of this concept are both essential to the nursing field. Currently, it would be important to focus on changing attitudes among psychiatric nursing staff to reduce the use of containment methods; this calls for more research on nursing staffs’ attitudes.     

公立医院编制规范化管理初探

本文在对编制管理现况分析的基础上,对上海市某医院编外人员的岗位分布、学历、职称及年龄结构进行分析：编外人员是一支十分年轻的专业队伍,更是医院最为活跃的、不容忽视的、医院长期可持续发展的后备军;调出的编外人员占全部调出人员的51.47%、编外人员调出率是编内人员调出率的3.48倍,给医院的人力资源管理及人才梯队建设造成极大影响。鉴于此,为稳定医院员工队伍,调动广大员工积极性,对转编的人员及原则、转编操作流程、转编考核方式等进行研究,探索公立医院编制管理的规范化管理路径,为医院编外人员转编提供规范、科学、有序的政策支持,进一步规范医院用工形式,为岗位设置、内部结构等级认定,提供基础并为绩效工资总量调整做好准备。     

浅析基层医院医患纠纷的原因及防范

近年来,基层医院医患纠纷逐年增多,通过1999²013年在基层工作实践体会,发现基层医院医患纠纷发生的原因多个方面:基层医院改革和管理不成熟,医务人员技术水平、沟通、服务不到位,医院内部不团结、缺乏自我保护意识;患者对医疗服务期望值过高、依从性差、经济条件差并法制观念薄弱;以及社会、媒体等方面的原因。对此,应当加强基层医院的内部管理、提高医务人员综合素质、加强医患沟通、增强自我保护意识,树立基层医院良好的形象,才能有效缓解医患关系的紧张,构建和谐的医疗环境。     

新疆某三甲医院医师岗位评价工作探索

目的通过调研,了解新疆某三甲医院人力资源管理的实际状况,人力资源管理存在的关键问题和薄弱环节,应用现代岗位评价方法对该院医师岗位进行评价。方法通过查阅国内外文献、年鉴、文件等相关资料,对医师的岗位做深入的了解。全面收集医院医师岗位评价指标。通过访谈法、德尔菲法、层次分析法,了解医师具体工作职责和相关的联系,构建二十九因素指标体系,运用因素评分法对医师岗位进行评价并将每一个岗位的评价得分数进行汇总。结果（1）通过课题研究梳理了医院206个医师岗位职责。（2）确定了二十九因素评价指标的权重。（3）计算了各医师岗位的评分。结论医师岗位价值评价与医师绩效分配结合,能够使医院绩效分配结果一步科学化、合理化。