医院联合体的构建及成效研究

介绍了浙江省温州医学院附属第一医院和温州市第八医院构建联合体的过程,阐明在卫生改革不断深入的形势下,医院联合体的组建既符合卫生改革的总体精神,也提高了医疗卫生资源的利用率,是我国卫生改革的一种走向,也是拆"围墙"打破各种隶属、所有制,优化卫生资源的必然趋势.它的最终目的是有利于盘活存量,资源共享,提高效益,有利于为人民提供优质医疗卫生服务[1],同时也为浙江省<深化医药卫生体制改革若干意见>的稳步实施提供了生动的案例,为行政主管部门的决策提供了借鉴.     

人力资源战略在医院管理中的运用及价值探讨

人力资源是医院最重要的资源,随着国内医疗市场的逐步开放和"三医"联动医药卫生体制改革的实施,医院之间的竞争愈加表现为人才的竞争,作为医院的高层管理者在战略决策管理中如何通过合理的人才战略和管理机制,吸引、培养、留下更多的人才并最大程度地调动他们的积极性和创造性显得十分重要.本文重点阐述了医院实施人力资源战略管理的方法,认为个人目标与组织目标保持高度一致,设计合理、灵活、富有激励的绩效考核办法是医院人力资源战略管理的关键所在.     

How to Effectively Implement an Indicator System to Improve Performance from a Management Perspective: The Case of Taiwan Healthcare Indicator Series (THIS) System

This study uses the Taiwan Healthcare Indicator Series (THIS) system as an example to examine which determinants would improve performance by sharing indicators from a management perspective. This study population included all 227 hospitals participating in the THIS system in 2006. A structured questionnaire was sent to the director who was responsible for the THIS system via electronic mail. A total of 111 responses were returned by February 10, 2006. Questions included current implementation and impacts of the system. Hierarchical regression models were performed to identify which variables were significantly associated with performance improvement, adjusted for hospital characteristics. Four variables significantly associated with implementing the THIS system to improve performance were ‘senior management support,’ ‘benchmarking,’ ‘making departments improve the underperforming indicators and report the improvement results in performance management meetings,’ and ‘integration with the National Health Insurance payment regulations’. This study contributes substantially to the evidence base about what works to improve performance by information sharing. Although information sharing is the basis of efforts to improve performance, senior management support and how to effectively apply the information are the most important determinants of performance enhancement.     

Decisions on Inclusion in the Swedish Basic Health Care Package—Roles of Cost-Effectiveness and Need

BACKGROUND: Inclusion or not of a treatment strategy in the publicly financed health care is really a matter of prioritisation. In Sweden priority setting decisions are governed by law in which it is stated that decisions should be guided by firstly the principle of need and secondly the principle of cost-effectiveness. OBJECTIVE: The purpose of the paper is to discuss and illustrate the roles of need and cost-effectiveness in decisions on inclusion or not of treatment strategies in the publicly financed health care. METHODS: The theoretical backgrounds of need and cost-effectiveness are discussed in short, both with respect to their meaning and to their potential roles in decisions on priority setting. Four treatment strategies, Viagra, Rivastigmine, statins, and lung transplants, are analysed with respect to whether either cost-effectiveness or need, or both, seem to have played a role in the decisions of inclusion or not in the basic health care package. RESULTS: Both need and cost-effectiveness are important and should be important aspects when making decisions on priority setting. From the examples of the four treatment strategies it seems that decisions are almost exclusively made with reference to the principle of need. CONCLUSIONS: The most evident conclusion to be drawn from this study is that decisions on priority setting are almost solely based on the principle of need. This implies that the principle of cost-effectiveness is given very little space, which is a problem as this means an obvious risk of inefficient resource use.     

Family Resources and Development of Social Competence in Disadvantaged Children in India

Family resources in terms of their qualitative (process) and quantitative (structure) nature influences the development of social competence in children/adolescents. Present study aims at exploring the relationship of family resource variables with three measures of social competence of 300 adolescent belonging to different socio-cultural status. Socio-culturally advantaged group samples were found to have healthy family environment, whereas, socio-culturally disadvantaged group perceived themselves as at disadvantages and were deprived in seeking positive intra-family support. However inspite of their disadvantages, they were found to be more self-competent. On the other hand, advantaged group adolescents were found to be more competent in the areas of peer and teacher related social competence. Product-moment coefficient correlation analysis revealed that parental education, occupation and family income were found to be significantly associated with positive peer and teacher related social competence in case of the samples belonging to the advantaged socio-cultural group. However, negative responses and outside family support was found to be positively associated with the development of disadvantaged group adolescent's self-related competence. In general, present study supports the hypothesis that Indian family system still continues to be considered as the major source of support for the adolescents, in spite of their growing tendency for independence, self-definition and autonomy.     

神农架“还阳”药调查初探

作者对湖北神农架地区民间流传的72“还阳”药深入调查,采集标本,总结报道了其功效、用法及种类,共有56种,属22科,其中有10种为新药物资源。药源极丰富,为开发利用提供了依据。     

几种具有抗疲劳、抗缺氧作用的藏药植物资源

由于藏民族主要生活在高海拔地区,因此在藏药中有许多著名的抗疲劳、抗缺氧药用植物资源,如红景天、沙棘等。本文整理了沙棘、冬虫夏草、蕨麻和红景天等几种(类)具有抗疲劳、抗缺氧作用藏药植物资源及其目前有关这些植物资源的开发利用研究状况,以期为开发运动员专用保健饮料和保健食品提供参考。     

Egg-sharing in assisted conception: ethical and practical considerations

The present acute shortage of eggs for donation cannot be overcomeunless adequate guidelines are set to alleviate the anxietiesregarding payments, in cash or kind, to donors. The currentHuman Fertilisation and Embryology Authority (HFEA) guidelinesdo not allow direct payment to donors but accept the provisionof lower cost or free in-vitro fertilization (IVF) treatmentto women in recognition of oocyte donation to anonymous recipients.Egg-sharing achieved in this way enables two infertile couplesto benefit from a single surgical procedure. However, the practicalguidelines related to this approach are ill-defined at the presenttime leading to some justifiable uncertainty. A pilot studywas therefore undertaken in order to establish the place ofegg-sharing in an assisted conception programme. The currentHFEA guidelines on medical screening of patients, counselling,age and rigid anonymity between the donor and recipient werefollowed. The study involved 55 women (25 donors and 30 recipients)in 73 treatment cycles involving fresh and frozen-thawed embryos.Donors were previous IVF patients who, regardless of their abilityto pay, shared their eggs equally with matched anonymous recipients.They paid only for their consultations and tests right up tothe point of being matched with a recipient The sole recipientpaid the cost applicable in egg donation of a single egg collection,although both received embryo transfers. The results indicatethat although the recipients were older than the donors (41.4± 0.9 versus 31.6 ± 0.5 years), and there wasno difference in the mean number of eggs allocated, the percentagefertilization rates, or the mean number of embryos transferred,there were more births per patient amongst recipients than amongstdonors (30 versus 20%). We conclude that providing the donorsare selected carefully, this scheme whereby a sub-fertile donorhelps a sub-fertile recipient is a very constructive way ofsolving the problem of the shortage of eggs for donation. Thereare also the advantages of including a group of women who wouldotherwise be denied treatment Problems related to ‘patientcoercion’ can, in our view, be fully overcome by the applicationof strict common-sense safeguards. The ideal of pure altruismis not without its medical and moral risk. The success of egg-sharingdepends on shared interests and a degree of altruism betweenthe donor, the recipient and the centre. The current HFEA guidelinesshould be applauded for enabling a highly effective conceptof mutual help to develop.     

建瓯市并殖吸虫种质资源及感染情况的调查

目的了解建瓯市并殖吸虫及媒介宿主的种类与感染情况。方法在调查点捕捉各种螺类与蟹类，检查其所携带的并殖吸虫并计算感染率。结果发现可充当并殖吸虫第一中间宿主的螺类有放逸短沟蜷、福建拟钉螺、建瓯洱海螺、小桥拟钉螺，其感染率分别为0、0．15％、0．42％与0．15％。充当并殖吸虫第二中间宿主的溪蟹有福建华溪蟹、福建马来溪蟹、角肢南海溪蟹，其感染率分别为46．60％、14．29％与12．50％。并殖吸虫虫种有卫氏并殖吸虫、斯氏狸殖吸虫、泡囊狸殖吸虫3种。其中，泡囊狸殖吸虫为新发现虫种。结论建瓯市并殖吸虫及媒介宿主物种资源丰富，为全省开展并殖吸虫病的调查和研究工作提供了病原线索。