门诊投诉原因分析与处理策略

目的：分析门诊投诉的原因和分布特征,提高门诊服务质量。方法：2006年1月～2008年6月门诊病人文字记录的投诉共计392份。对数据进行统计处理并回顾性分析。结果：392例投诉中,服务态度投诉所占比例最高;其次是丁作马虎、不认真;对医疗行业的不理解;医院内部流程或协调缺陷的投诉,经过优化就诊流程,投诉明显下降。结论：医院应转变服务观念、增强服务意识、改善服务态度,提供优质服务。同时应加强门诊管理,优化医院内部流程;门诊医疗投诉应引起医院管理部门的重视,积极妥善处理。     

储值就诊卡在门诊医疗服务中的应用

目的是探讨“储值就诊卡”诊疗模式在门诊诊疗工作中所发挥的作用。方法总结我院3年多来在门诊医疗服务应用“储值就诊卡”诊疗服务系统的经验。结果表明“储值就诊卡”诊疗模式为医院门诊医疗提供了高效的作业工具,提高了门诊的诊疗工作效率和管理水平,为医院管理层提供门诊医疗信息,也为群众提供舒适,方便,高效,快速的人。眭化服务。     

门诊就诊病人的投诉原因及对策

门诊是医院对外的重要服务窗口,也是病人就诊的主要场所,担负着繁重的医疗任务,因其服务对象复杂,病人就诊相对集中,医务人员素质参差不齐,就诊手续繁琐等特点.近年来,随着人们生活水平提高,对法律意识的不断增强,而医院门诊的服务,医疗技术和管理水平等均难以满足病人的要求,故病人的投诉常有发生,本院2003年11月至2005年6月共发生31例门诊投诉,下面就其发生的原因及相应的防范对策加以分析.     

门诊就诊病人的投诉原因及对策

门诊是医院对外的重要服务窗口，也是病人就诊的主要场所，担负着繁重的医疗任务，因其服务对象复杂，病人就诊相对集中，医务人员素质参差不齐，就诊手续繁琐等特点。近年来，随着人们生活水平提高，对法律意识的不断增强，而医院门诊的服务，医疗技术和管理水平等均难以满足病人的要求，故病人的投诉常有发生，本院2003年11月至2005年6月共发生31例门诊投诉，下面就其发生的原因及相应的防范对策加以分析。     

“互联网+”医疗在门诊特殊疾病管理中的应用与思考

目的/意义 根据四川省人民医院互联网门诊特殊疾病服务试行经验,有针对性地提出思考和建议,为进一步推进“互联网+”医疗在门诊特殊疾病管理中的应用提供参考。方法/过程 基于互联网医院运行数据,从就诊人次、就诊科室及投诉反馈等方面分析互联网门诊特殊疾病服务的运行情况和存在问题。结果/结论 目前互联网门诊特殊疾病服务存在利用率不高、处方流转不畅、药品配送不及时等问题,应针对重点人群优化线上服务、建立区域电子处方共享平台、完善药品配送体系、加强不同层级医疗机构的合作并构建区域化门诊特殊疾病管理体系。     

门诊投诉原因分析及管理措施

目的：探讨门诊投诉的原因及特点,提出合理的投诉管理措施,提高门诊的服务质量。方法：回顾性分析门诊办公室的投诉资料,考察门诊投诉发生的原因,提出投诉管理措施。结果：门诊投诉主要集中在服务与沟通、各科室的医生中,投诉的解决方式主要通过与科室协商及门诊办公室解释,获取患者谅解,化解纠纷;医院管理部门通过公示投诉、绩效考核、严格出停诊管理、宣传沟通渠道及加强门诊服务规范性等措施,可减少门诊投诉。结论：医院门诊应以病人为中心,增强服务意识,改善服务态度,为患者提供优质的医疗服务,同时重视门诊投诉,及时解决,并采取合理有效的投诉管理措施,有利于避免各类医疗纠纷投诉的发生,提高医疗服务质量,构建和谐的医患关系。     

门诊医疗投诉原因分析及防范对策

目的 分析医院门诊医疗投诉发生的常见原因,采取有效防范措施.方法 分析门诊医疗投诉的常见原因,采取强化规章制度落实、优化就诊环境和门诊诊疗流程、加强医德医风教育及服务意识、规范门诊医疗文书书写等防范措施.结果 实施防范措施后接待的门诊有效医疗投诉123起,投诉下降率为35%.满意度由92%上升至96%.结论 掌握并分析门诊医疗投诉发生原因,采取针对性的防范措施,才能有效地解决当前医患关系紧张的问题,构建和谐的医患关系.     

门诊老年患者的投诉原因分析与对策

目的通过对门诊老年患者投诉情况及原因分析,制订对策,提高老年患者就诊满意度.方法对2007年至2008年共1100例门诊老年患者投诉进行回顾性分析.结果老年患者的投诉涉及服务态度、医疗护理质量、就诊流程、医院规章制度、现行政策等多个方面,分别占到总投诉量的47.45%、19.18%、15.09%、4.82%和8.27%.结论随着社会进入老龄化,门诊医疗服务更应多方面、多角度、有意识地关注老年患者,开展适合这类特殊人群的细节服务,提高老年患者的就诊满意度.     

药师在防范门诊药房投诉事件中的作用

门诊药房是医院的窗口服务部门,也是目前门诊医疗投诉的一个重要方面。因此,如何有效地防范和处理门诊药房投诉,具有重要的理论和实践意义。本文通过对引起门诊药房投诉事件中药师方面的原因进行分析,探讨有针对性的防范措施,指出通过严格执行规章制度和操作规程、强化法律意识和自我保护意识、转变观念、强化服务意识等各项措施加强药师整体素质的提高,从源头上有效地防范门诊药房投诉事件的发生,创建和谐的“药患关系”,从而提高医院药房的整体服务质量。     

门诊部投诉原因探索及防范措施

门诊是医院的重要组成部分,因其具有服务对象构成复杂、就诊高峰相对集中、服务场所点多面广、工作人员素质参差不齐、就诊手续繁琐等特点和问题,所以常是病人投诉的多发部位.投诉处理不好,极易引发医疗纠纷,必须引起治理者的重视.2005年3月～2006年9月对门诊部发生的25起投诉的原因进行分析,并提出相应防范措施.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.