Safety and efficacy for laparoscopic versus open hepatectomy: A meta-analysis

Background

Laparoscopic hepatectomy (LH) is growing in popularity, but its efficacy and safety are still controversial. Few multicenter, large, population-based, prospective, randomized studies have compared LH with open hepatectomy (OH). We performed a meta-analysis to compare the treatment outcome of patients undergoing LH versus OH.

Assessing stability and performance of a digitally enabled supply chain: Retrospective of a pilot in Uttar Pradesh,India

BackgroundImmunization supply chains in low resource settings do not always reach children with necessary vaccines. Digital information systems can enable real time visibility of inventory and improve vaccine availability. In 2014, a digital, mobile/web-based information system was implemented in two districts of Uttar Pradesh, India. This retrospective investigates improvements and stabilization of supply chain performance following introduction of the digital information system.MethodsAll data were collected via the digital information system between March 2014 and September 2015. Data included metadata and transaction logs providing information about users, facilities, and vaccines. Metrics evaluated include adoption (system access, timeliness and completeness), data quality (error rates), and performance (stock availability on immunization session days, replenishment response duration, rate of zero stock events). Stability was defined as the phase in which quality and performance metrics achieved equilibrium rates with minimal volatility. The analysis compared performance across different facilities and vaccines.ResultsAdoption appeared sufficiently high from the onset to commence stability measures of data quality and supply chain performance. Data quality stabilized from month 3 onwards, and supply chain performance stabilized from month 13 onwards. For data quality, error rates reduced by two thirds post stabilization. Although vaccine availability remained high throughout the pilot, the three lowest-performing facilities improved from 91.05% pre-stability to 98.70% post-stability (p < 0.01; t-test). Average replenishment duration (as a corrective response to stock-out events) decreased 52.3% from 4.93 days to 2.35 days (p < 0.01; t-test). Diphtheria-tetanus-pertussis vaccine was significantly less likely to be stocked out than any other material.ConclusionThe results suggest that given sufficient adoption, stability is sequentially achieved, beginning with data quality, and then performance. Identifying when a pilot stabilizes can enable more predictable, reliable cost estimates, and outcome forecasts in the scale-up phase.     

专科医院科主任质量管理现状调查

目的了解专科医院科主任开展医疗质量管理的基本情况,探索提升科主任管理医疗质量水平的途径。方法采用调查表对某专科医院医疗和医技科室的正副主任进行调查。结果14名科主任有考核标准,2名科主任没有,1名不清楚。管理知识和领导能力是科主任管理科室医疗质量的主要技能,其次是业务知识和能力,第三位是个人魅力。14名科主任参加过管理培训,占77．8％,4名没有参加过,占22．2％。结论应重视科主任管理知识的培训,采用多种方式提升管理的积极性,并制定统一的考核标准提升科主任管理科室的能力。     

美国医院个案管理师概况与启示

从个案管理师的定义、资质认证、角色定位、工作职能、个案管理干预方法等方面，对美国医院个案管理师的培养和使用情况进行介绍。指出制定个案管理师培养方案，构建资质认证标准，完善岗位职能，建立个案管理师培养与使用机制，将是我国医院个案管理师的研究方向。     

时间管理在护理管理人员中的应用与思考

时间管理是掌握和利用时间的科学和艺术，时间管理对于护理管理人员具有重要意义，例如可以提高工作效率、减轻职业倦怠、提高护理管理水平等。当前我国医院护理管理人员对时间管理重视程度普遍不够，不少护理管理人员对时间管理仍然采用经验式管理的方式。因此，应当加强护理管理人员对时间管理的认识，同时护理管理人员应当了解时间管理原则，灵活运用时间管理方法，同时掌握一些时间管理技巧，如学会记录、适当授权等。     

乳腺癌个案管理师核心能力评价指标的构建

目的 构建适合中国国情的乳腺癌个案管理师核心能力评价指标。 方法 通过查阅文献和专家组分析,课题组整理讨论后拟订专家咨询问卷,于2019年10月—12月对中国北京市、广东省、浙江省、广西壮族自治区、台湾等省份的三级甲等专科医院及综合医院的19名乳腺肿瘤医疗及护理专家进行专家咨询。 结果 共开展2轮专家咨询。最终确立的乳腺癌个案管理师核心能力评价指标包括一级指标5个、二级指标12个、三级指标43个。专家咨询的专家权威系数均为0.93,熟悉程度系数为0.92、0.91,判断依据系数均为0.95;第1轮专家咨询各级指标肯德尔和谐系数为0.121~0.208,第2轮专家咨询各级指标肯德尔和谐系数为0.191~0.341。 结论 乳腺癌个案管理师核心能力各级评价指标专家咨询意见趋于一致,可信度高,可为乳腺癌个案管理师的培训、考核、评价提供可量化的参考依据。     

煤炭企业管理者应对方式及其与心身健康关系的研究

目的探讨煤炭企业管理者主要应对方式及其与心理健康的关系。方法在开滦10万人口的总样本中,抽取比例为5％（10万人×5％=5000人）,采用分层整群随机法确定管理者样本为1146人。以特质应对方式量表（TCSQ）、简易应对方式量表（SCSQ）评定管理者的应对方式,以一般心理健康量表评定管理者的心理健康水平,以症状自评量表（SCL-90）评定管理者的精神症状。结果特质积极应对和特质应对活跃的压力值明显低于特质消极应对和特质应对逃避的压力值（P〈0．001）,简易积极应对方式的压力水平也低于简易消极应对方式的压力水平。除了简易积极应对与SCL-90相关不显著外,特质积极与SCL-90症状呈显著负相关,特质消极和简易消极与SCL-90症状均呈显著正相关。结论越积极应对,心理越健康,心身越健康;越消极应对,心理越不健康,心身越不健康。     

The immunogenicity of injectable collagen. I. A 1-year prospective study

With the growing use of collagen-based biomaterials, questions have been raised regarding the immunogenicity of this protein in humans. Currently a bovine collagen implant is in widespread use for the correction of dermal contour deficiencies ( Zyderm Collagen Implant (hereafter referred to as "the implant"); Collagen Corporation, Palo Alto, CA). To investigate potential immunologic consequences of this material, sixty-one subjects were evaluated in a 1-year prospective study. Two of the sixty-one subjects (3%) experienced localized, self-limiting inflammatory responses to the implant material; only in these two subjects could elevated levels of anti-implant collagen antibodies be measured by radioimmunoassay. These antibodies did not cross-react with human dermal collagen nor did they result in elevated levels of circulating immune complexes. Routine blood and urine testing failed to reveal any results of clinical significance. Thus, this protein displayed only weak antigenic activity in this study population.     

医用耗材的管理制度和建议

随着医疗水平的不断进展，技术水平的提高，耗材的品种也不断增加，供应商也不断增多。面对这种多样化的扩大，耗材管理上也面临很大挑战。目前耗材的应用现状出现或这或那的问题，所以如何健全耗材合理化的制度和管理，使其发挥最大的经济效益，是本文探讨的主要内容。