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1.
普陀区小学生营养午餐营养素供给与质量评价   总被引:2,自引:0,他引:2  
目的了解配送中心学生营养午餐营养素供给和饭菜质量,为促进小学生健康成长提供依据。方法随机抽取普陀区教育局服务配送中心配送营养午餐的2所公办小学学生及家长1 023名进行调查,了解学生、家长对配送中心供应的饭菜质量满意度,并对菜谱进行营养素分析。结果午餐提供的蛋白质、铁、维生素C等营养素分别超过供给量标准的15.4%,10.4%和63.9%,但能量、钙、锌、维生素A、维生素B1、维生素B2等营养素的供给量相对不足,钙仅达到供给量的27.9%。家长和学生总体满意度良好,家长对学校午餐的建议中丰富花色品种、冬天饭菜做好保温、重视营养居前3位。结论应适当调整午餐膳食结构,增加奶类、豆类、深绿色蔬菜、海产品的比重,改善午餐质量。  相似文献
2.
A systematic review of measures of end-of-life care and its outcomes   总被引:2,自引:0,他引:2  
OBJECTIVE: To identify psychometrically sound measures of outcomes in end-of-life care and to characterize their use in intervention studies. DATA SOURCES: English language articles from 1990 to November 2005 describing measures with published psychometric data and intervention studies of end-of-life care. STUDY DESIGN: Systematic review of end-of-life care literature. EXTRACTION METHODS: Two reviewers organized identified measures into 10 major domains. Eight reviewers extracted and characterized measures from intervention studies. PRINCIPAL FINDINGS: Of 24,423 citations, we extracted 200 articles that described 261 measures, accepting 99 measures. In addition to 35 measures recommended in a prior systematic review, we identified an additional 64 measures of the end-of-life experience. The most robust measures were in the areas of symptoms, quality of life, and satisfaction; significant gaps existed in continuity of care, advance care planning, spirituality, and caregiver well-being. We also reviewed 84 intervention studies in which 135 patient-centered outcomes were assessed by 97 separate measures. Of these, 80 were used only once and only eight measures were used in more than two studies. CONCLUSIONS: In general, most measures have not undergone rigorous development and testing. Measure development in end-of-life care should focus on areas with identified gaps, and testing should be done to facilitate comparability across the care settings, populations, and clinical conditions. Intervention research should use robust measures that adhere to these standards.  相似文献
3.
Objective. To identify primary care practice characteristics associated with colorectal cancer (CRC) screening performance, controlling for patient-level factors.
Data Sources/Study Setting. Primary care director survey (1999–2000) of 155 VA primary care clinics linked with 38,818 eligible patients' sociodemographics, utilization, and CRC screening experience using centralized administrative and chart-review data (2001).
Study Design. Practices were characterized by degrees of centralization (e.g., authority over operations, staffing, outside-practice influence); resources (e.g., sufficiency of nonphysician staffing, space, clinical support arrangements); and complexity (e.g., facility size, academic status, managed care penetration), adjusting for patient-level covariates and contextual factors.
Data Collection/Extraction Methods. Chart-based evidence of CRC screening through direct colonoscopy, sigmoidoscopy, or consecutive fecal occult blood tests, eliminating cases with documented histories of CRC, polyps, or inflammatory bowel disease.
Principal Findings. After adjusting for sociodemographic characteristics and health care utilization, patients were significantly more likely to be screened for CRC if their primary care practices had greater autonomy over the internal structure of care delivery ( p <.04), more clinical support arrangements ( p <.03), and smaller size ( p <.001).
Conclusions. Deficits in primary care clinical support arrangements and local autonomy over operational management and referral procedures are associated with significantly lower CRC screening performance. Competition with hospital resource demands may impinge on the degree of internal organization of their affiliated primary care practices.  相似文献
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The General Medical Council procedures to assess the performance of doctors who may be seriously deficient include peer review of the doctor's practice at the workplace and tests of competence and skills. Peer reviews are conducted by three trained assessors, two from the same speciality as the doctor being assessed, with one lay assessor. The doctor completes a portfolio to describe his/her training, experience, the circumstances of practice and self rate his/her competence and familiarity in dealing with the common problems of his/her own discipline. The assessment includes a review of the doctor's medical records; discussion of cases selected from these records; observation of consultations for clinicians, or of relevant activities in non-clinicians; a tour of the doctor's workplace; interviews with at least 12 third parties (five nominated by the doctor); and structured interviews with the doctor. The content and structure of the peer review are designed to assess the doctor against the standards defined in Good Medical Practice , as applied to the doctor's speciality. The assessment methods are based on validated instruments and gather 700–1000 judgements on each doctor. Early experience of the peer review visits has confirmed their feasibility and effectiveness.  相似文献
6.
Objective. To determine whether clinical vignettes can measure variations in the quality of clinical care in two economically divergent countries.
Data Source/Study Setting. Primary data collected between February 1997 and February 1998 at two Veterans Affairs facilities in the United States and four government-run outpatient facilities in Macedonia.
Study Design. Randomly selected, eligible Macedonian and U.S. physicians (>97 percent participation rate) completed vignettes for four common outpatient conditions. Responses were judged against a master list of explicit quality criteria and scored as percent correct.
Data Collection/ Extraction. An ANOVA model and two-tailed t-tests were used to compare overall scores by case, study site, and country.
Principal Findings. The mean score for U.S. physicians was 67 percent (+/−11 percent) compared to 48 percent (+/−11 percent) for Macedonian physicians. The quality of clinical practice, which emphasizes basic skills, varied greatly in both sites, but more so in Macedonia. However, the top Macedonian physicians in all sites approached or—in one case—exceeded the median score in the U.S. sites.
Conclusions. Vignettes are a useful method for making cross-national comparisons of the quality of care provided in very different settings. The vignette measurements revealed that some physicians in Macedonia performed at a standard comparable to that of their counterparts in the United States, despite the disparity of the two health systems. We infer that in poorer countries, policy that promotes improvements in the quality of clinical practice—not just structural inputs—could lead to rapid improvements in health.  相似文献
7.
新医改中的公立医院取消“以药养医”后的补偿机制分析   总被引:1,自引:0,他引:1  
我国的新医改政策指出,公立医院要取消药品加成政策.医院由此减少的收入或形成的亏损,通过增设药事服务费调整部分技术服务收费标准增加政府投入来解决.文章对医院管理中这三条补偿途径分别做了详尽的分析,认为增设药事服务费不可取;调整部分技术服务收费标准要获得民众的认可,就要大幅度提升服务质量;增加政府投入是必然,但更要加强政府监管.  相似文献
8.
强化医院科室的环节管理   总被引:1,自引:0,他引:1  
陈洪高 《现代医院》2008,8(8):121-122
为探索做好医院科室日常管理工作的有效办法,笔者从落实规章制度入手,加大了以下环节的管理力度:①医护人员的执业准入和技术培训;②病情告知的规范和工作流程的确立;③疑难病人的诊断和危重病人的抢救;④有创诊疗的指导和病历质量的审核;⑤重要岗位的配置和重点人员的管理;⑥医疗成本的监控和医德医风的检查。通过强化关键环节的管理,调整影响环节管理的主要因素,创新管理办法,科室的管理水平和医疗服务质量明显提高。  相似文献
9.
云南罗平医院门诊患者满意度调查研究   总被引:1,自引:0,他引:1  
为探讨通过门诊患者满意度调查提高医疗服务质量和医院综合实力的方法及途径,本文以云南罗平医院为研究对象,调查了该医院324个门诊患者。对调查结果进行分析,探讨该院门诊医疗服务的优势和问题所在,找出影响总体满意度的关键因素,并提出相应改进对策。  相似文献
10.
The relation between gender, personality, school scores, grades at medical school and eventual achievement as a medical practitioner 8 years after qualifying has been explored by path analysis in a cohort of medical students. Factor analysis of data derived from a questionnaire identified a significant factor accounting for 75% of the common variance of the professional achievement scores. Standardized path coefficients were computed to indicate the relative importance of the causal factors to postgraduate achievement. Gender played an important role at many levels. For example it was apparent that many of our women graduates were seriously disadvantaged in their professional careers. Of the school subjects, chemistry was a surprising long-term predictor of postgraduate achievement. Academic achievement during medical school training, particularly in the final year, was a significant predictor, while personality attributes made their contribution to one or other aspect of achievement at earlier stages in training but made little additional direct contribution to postgraduate performance.  相似文献
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