迎接知识经济时代的医院建设

知识经济是以知识创造财富的经济,作为医院在迎接知识经济时代到来时,尚存在一些与之不相适应的问题。为了迎接新的经济时代,我们天坛医院的发展策略是：一是革新观念,即要有定位观和发展观及知识生产率观;二是调整医院发展战略;三是利用全球资源;四是提高医院整体素质。在当前,既要克服知识经济已经到来的倾向,又要克服遥不可及的倾向。扎实做好工作,尤其要完善创新人才的引进制度。     

医疗保险制度改革使医院面临新的决策

医疗保险制度改革对医院既是机遇，也是挑战，作为医疗保险制度改革的支撑系统——医院，要适应卫生系统宏观经济环境的改变。为此：①扩大服务范围；②调整经营方式；③内强素质与外树形象；④合理配置设备。在此基础上，改革不合理的经营补偿机制，增加医院自主分配权，鼓励技术竞争，提高医务人员待遇和管理水平，从而使医院在新的环境中获得新的发展。     

贫困县医院的医疗服务和收支分析

为了研究贫困县的医疗保健制度、县医院的地位、医疗费用结构等，对东兰、旬邑县医院的财务和统计资料及医疗服务的提供和费用结构情况等进行了调研。结果表明，县医院在农村医疗工作中发挥着重要作用；在医院收入结构中，药品所占比重最高，医疗收入其次，财政拨款所占比重最低且数额逐年下降，不足以支付医院人员的劳务费；在医院支出中，药品也占据了最大份额，其次为劳务支出；医院经营补偿机制的不合理，促使医院追求次均费用，这一方面加重了贫困地区农民的负担，另一方面也使医院忽视了基本医疗服务的提供，降低了服务的质量与效果。     

医院内部审计的风险研究

本文从医院内部审计的现状出发，寻求医院内部审计的发展方略。合理设置医院内部审计的组织系统，明确医院内部审计的性质地位，转变现有的医院内部审计模式，加强医院内部审计的行业性管理及医院内部审计法律法规制度建设等，将有助于医院内部审计的发展，从而为深化医院治理和卫生改革保驾护航。     

医疗保险对医院管理的影响

实行职工医疗保险制度改革后，医院功能将有所拓展，医院投入和补偿机制将面临宏观调整，医院管理、监督和控制将得到强化，医院竞争机制和配套制度将发生深刻变化。因此，实行职工医疗保险制度改革后，医院的管理模式和管理重点也将随之发生变革。医院应转变观念，调整经营方向，规范内部管理，抓住关键指标，控制医疗成本，优化资源配置，提高资源效率，发展自动化、网络化的医院信息管理系统，以及建立客观新型的评估体系等，主动适应医疗保险制度改革的需要。     

浅谈部分军队医院卫生干部技术档案的问题与对策

医院建立卫生干部技术档案是为了记录每个卫生干部的专业技术水平和实际工作能力，为组织培训、选拔使用干部及调职、晋级提供主要依据。但目前档案管理存在的问题有：①观念陈旧，对技术档案的重要性认识不足；②管理松懈，管理制度不落实；③利用率低，技术档案作用发挥不好。解决这些问题的措施：一是加强学习，提高素质；二是强化管理，落实制度；三是加速建设，积极利用。     

论医院形象

良好的医院形象是一笔无形资产。在医疗保险制度全面推开之际，医院形象关系到医院的生存与发展。作为医院形象是由质量、服务、员工、技术人才、设备、环境、地理位置等构成。由于医院形象的特殊作用，医院管理者应重视塑造医院的良好形象。为此，就要确立医院的发展战略，站在社会、患者的立场上观察和制定医院的各项服务规范，在提高医疗质量的基础上狠抓医院内涵建设，开展以病人为中心的优质、高效、整体的医疗保健服务。从而使医院在社会、患者中拥有良好的美誉度。     

论社会医疗保险与医疗卫生事业的协调发展

医疗制度改革与医疗卫生事业有密切联系，表现为：①两者均以保障职工健康服务为根本宗旨，具有目的的一致性；②医疗保险在资金上保障医疗需求，医疗服务从技术上保障医疗需求，具有功能的统一性；③医疗保险提供经费补偿，医院通过医疗服务获得经济补偿，具有资源的互补性。为此，医疗保险与医疗卫生事业必须协调发展。实施社会医疗保险制度，有利于医疗卫生事业稳定、健康、协调发展。表现为：①实行社会医疗保险后，被保险人责、权、利统一，原过度的医疗需求被抑制，原抑制的需求获释放，有利于区域医疗卫生规划合理化；②实施社会医疗保险，建立了强制性的筹资机制和与工资同步的增长机制，有利于医疗卫生事业稳定合理的资金投入；③实行社会医疗保险，可改变医疗服务垄断市场的地位，有利于推进医院经营管理；④实行社会医疗保险，采用医疗保险与卫生行政管理结合模式，有利于卫生行政管理职能转变。     

医院内部审计的发展方略

试从医院内部审计的现状出发,寻求医院内部审计的发展方略.合理设置医院内部审计的组织系统,明确医院内部审计的性质地位,转变现有的医院内部审计模式,加强医院内部审计的行业性管理及医院内部审计法律法规制度建设等,将有助于医院内部审计的发展,从而为深化医院治理和卫生改革保驾护航.     

加强内涵建设提高医院整体水平

坚定不移地走内涵发展的路子，就是要走质量效益型的发展道路，依靠科技、管理和改革，最大限度地发挥现有卫生资源的效益；通过高质量、低消耗、快节奏的医疗工作为患者提供全程优质医疗服务，赢得社会声誉，是巩固和发展“三甲”医院评审成果、推进医院建设迈上新台阶的有效途径。工作中我们注意做好４个方面的工作：一是保证基础医疗质量，提高整体医疗水平；二是加强人才培养和学科建设，增强医院后劲；三是合理利用卫生资源，提高医疗工作效率；四是强化管理，提高医院的综合效益。解放军总医院     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.