University and Community Hospital Medical Student Emergency Medicine Clerkship Experiences

Objective : To determine whether there is a significant difference between educational opportunities for fourth-year medical students rotating at a university hospital (UH) compared with several community hospitals (CHs) during a mandatory emergency medicine (EM) clerkship.
Methods : A self-reported clinical tool was completed in real time by each student rotating for 2 weeks at the UH and 2 weeks at 1 of 4 CHs (3 affiliated and 1 unaffiliated). Students are required to document the number of patients seen and the number of procedures performed on each of 20 six-hour shifts. They rated the EM attending clinical teaching by site using a 5-point scale at the end of the clerkship.
Results : Most (95%) of the 87 students in the 7 clerkship blocks of the 1996–97 academic year rotated at the UH and a CH. Most (71%) students rated both the UH and the CH for the quality of teaching by attendings. There was a significant difference in the mean number of patients evaluated/shift (2.2 ± 0.10 vs 2.8 ± 0.10, UH vs CH; p < 0.001) and the mean number of procedures performed/shift (0.36 ± 0.04 vs 0.56 ± 0.05, UH vs CH; p < 0.001). Attending clinical teaching scores were significantly higher (p = 0.03) at the CHs.
Conclusions : The educational opportunities for students in an EM clerkship to evaluate patients and perform procedures were significantly greater at the community hospitals. Inclusion of community hospital settings in a medical student EM clerkship may optimize the clinical experience.     

医院药品历史数据利用的实验

药品管理是医院管理的一个重要方面,在传统模式基础之上,如何利用新的技术改善管理也是管理人员和信息技术人员所关注的.本文介绍的实验就是采用数据仓库技术,结合医院的应用,进行的有意义尝试,并对实验过程中的数据源、平台搭建、数据抽取、定义、处理,以及工具的选择等方面,进行了详细的介绍.     

腹部多脏器损伤的救治

报告了腹部多脏器损伤１５８例的救治情况。致伤因素中交通事故和高空坠落伤占６７．０％，抢救存活１３２例，存活率８３．５％；死亡２６例，病死率１６．５％。作者分析了病死率与致伤暴力强、现场急救延误、就诊时间及受伤的脏器数的密切关系。作者认为院前救护、院内正确诊断、及时治疗、果断手术是抢救成功的重要环节；术中应仔细探查、止血，术后应注意防治多脏器衰竭的发生。     

优势医院在医院重组和集团组建中作用的研究

目的:研究优势医院在医院重组和集团化中的作用;方法:借鉴优势企业理论,从医疗、科研、领先学科和人才等因素分析,确立优势医院;结果:三级医院尤其是大学附属教学医院是当之无愧的优势医院;结论:发挥优势医院在医院重组和集团化以及建立“小病进社区,大病到医院”两级医疗服务模式改革中的作用,才能带动区域内医疗水平的提高。     

临床医师处方抗菌药物前需思考的几个问题

2001年和2003年卫生部全国医院感染监测网调查结果均显示,医院横断面抗菌药物的平均使用率在54%以上,联合用药较为普遍.国内监测结果也表明细菌耐药性日益严重.针对上述问题,提出临床医师在面对病人开处方抗菌药物之前,须思考的问题:是否有使用抗菌药物的适用症?是否了解选用的抗菌药物,选用何种药物?是否有联合使用抗菌药物的指征?采用何种给药途径、给药剂量、给药时间?是否属于特殊宿主或针对特殊病原体的感染使用抗菌药物?密切观察抗菌药物治疗是否有效?针对局部感染是否需要穿刺或外科手术引流病灶?是否已出现抗菌药物的不良反应?是否存在药物相互作用?是否存在不合理使用抗菌药物情况?并且针对每个问题提出了建议.     

The hospital as an enterprise: management strategies

After introducing the context in which health systems exist in developing as well as in industrialized countries, the author describes the role that hospitals are expected to play as 'enterprises'. The rationale behind such a role is explored and the experience so far available discussed. Evidence from several developing countries suggests caution and tends to discourage radical and indiscriminate introduction of market‐oriented reforms, which international donors seem to be spearheading in Africa's health systems. It is likely, however, that a limited, gradual introduction of selected elements of these reforms (such as some aspects of contracting out, managerial decentralization, the split between purchasing and providing functions) may find its place and eventually have a positive impact on the performance of the health systems. But the 'mystique of markets' must not be allowed to deprive public hospitals of the sense of social utility and of the caring ethos which are essential requisites of a meaningful and effective public health system.     

我院平均住院日状况的调查分析

目的：通过对医院平均住院日情况的简要分析，以探索缩短平均住院日的有效途径。方法：从统计室提取数据，与病案核对，计算相对指标。结果：我院的平均住院日呈下降趋势，但与卫生部颁布的标准还有差距，中医各科和康复科科别的平均住院日更长一些。结论：我院的平均住院日还有潜力可挖，术前住院日多数病种都较长，应在医疗质量和护理质量上狠下功夫，加强科室间的协作，降低平均住院日，减少无效住院日。     

提高住院分娩率和产科质量是降低孕产妇死亡率的关键

本研究以河北省４个妇幼卫生项目县为现场，对１９９０年１月１日～１９９２年１２月３１日三年间全部死亡孕产妇与其有关的卫生服务及死因进行了调研。结果表明：调研地区孕产妇死因前两位为产科出血、产褥感染。可能与其大部分在家分娩，由未经培训过人员接生、接生质量低劣等有关。从而提出，提高住院分娩率和产科质量是降低孕产妇死亡率的关键。还提出，全社会重视妇女受教育的问题，提高妇女的社会地位，使其拥有生殖权力是提高住院分娩率的重要条件。     

医院实物资产管理在成本费用控制中的作用

医院实物资产作为一个关键性的成本改善领域,越来越引起人们高度重视。加强医院实物资产管理是医院成本费用控制的发展趋势,把医院实物资产管理的各个环节作为一个整体进行管理,在管理体制上实现了经费、实物资产管理的统供统管,规范了医院经济活动,产生了良好的效益。