系统仿真技术在优化妇科门诊治疗流程中的应用研究

目的 优化妇科门诊治疗流程,提高医疗服务水平和资源利用率.方法 对无锡某医院妇科门诊治疗中心的工作流程进行调查,根据病人病情和治疗方案的不同,将病人分为5组,收集每组病人到达时间间隔及治疗时间,运用MedModel专业软件建立该院妇科门诊治疗流程的仿真模型,分别模拟目前的工作流程和改进方案.结果 在现行的工作流程和资源分配模式下,病人的平均等候治疗时间较长.通过优化医疗资源配置和病人就诊次序,第二和第三治疗室的病人候诊时间可分别从7.07s和10.47 s缩短为3.04 s和5.07 s.结论 仿真结果显示改进后的方案在资源利用和病人候诊时间方面比较合理,是目前妇科门诊治疗中心较好的运行方案.     

医院电子申请单预约及排程模型优化设计分析

目的对医院检查电子申请单预约及排程方法进行改进,优化患者的预约时间．提高医疗设备的利用率。方法分析现有的电子申请单的工作流程,提出改进方案。结果提出了一套高效动态的预约排程系统．优化了医院检查流程。结论该系统既优化了病人的预约时间．又提高了医院检查设备的利用率。     

基于成本当量法的医疗服务项目成本核算研究进展与思考

作者通过文献研究法, 分析基于成本当量法的医疗服务项目成本核算研究进展。根据成本当量值的计算模式将该方法归纳为当量系数法和点数法。对成本当量法在医疗服务项目成本核算中的运用现状进行分类总结, 分析了成本当量法的优势, 如能够考虑多种成本动因、核算流程简洁且可操作性强等;探讨该方法存在的问题, 并对进一步深化运用成本当量法和加强医院成本核算工作提出建议, 包括加强成本当量法的总结和案例宣传, 合理组合运用多种成本核算方法, 科学合理开展医院成本核算信息化建设, 以期助力构建科学、精准的医疗服务项目成本核算体系。     

药品零差率下新疆各级公立医疗机构医疗服务价格调整方案

目前,医疗卫生服务当中的技术服务的劳动价值没有得到合理体现,医疗技术服务费用,特别是挂号、床位、诊疗、会诊、护理和一些高难度手术的收费价格还低于成本很多,为此,有必要对医疗服务价格进行调整。文章主要结合新疆公立医疗机构的特点,对医院的医疗服务项目成本进行系统的分析,研究药品零差率下医疗服务价格的具体调整方案。     

精益六西格玛在提高医疗设备维修效率中的应用研究

目的 :减少医疗风险,发挥现有医疗设备的能效,提高医院医疗设备的维修保障效率。方法 :运用精益的哲理、方法和工具,采用六西格玛"定义—测量—分析—改进—控制"的流程,通过对医疗设备维修流程的分析,找出问题,改进不足,提高维修质量和效率。结果:通过对医疗设备维修保障中精益六西格玛应用方法的分析研究,减少了医院医疗设备维修过程中时间和物资的浪费,提高了医疗设备维修效率。结论:该方法确保了医疗设备的维修质量,保障了医疗工作的正常运行,可供同行参考、借鉴。     

医院成本核算在DRGs实施过程中的作用研究

目的：探究DRGs支付方式下医院成本核算的方法与对策,并提出DRGs支付方式下医院成本管控的具体措施。方法：以医院成本核算系统中项目成本数据为基础,把为治疗同一病组所耗费的医疗项目成本、药品成本及单独收费卫生材料成本进行叠加,计算例均成本。结果：通过对疾病诊断相关分组下的成本核算方法进行研究,并对疾病相关诊断组的成本构成进行精细化分析,探索出标准化成本管控流程及动态平衡的医保支付机制。结论：DRGs支付方式下,医院应当更加强化成本核算和成本管控,从而进一步降低医疗服务成本、提高资源的利用率。     

作业成本法在项目成本核算中的应用

与传统的成本核算方法相比,作业成本法提供了一种全新的成本理念,可更有效归集和分配间接成本,该方法通过分析成本动因,使医院成本管理重心深入到作业层次,优化作业流程,提高医院成本管理效益。以作业成本法为核心构建医院作业成本核算系统核算医疗项目成本,设计作业链,确定成本动因,进行成本分析,为医院管理和宏观决策提供更准确合理的成本核算资料。     

作业成本法在医院流程管理中的应用研究

流程成本管理是医院流程管理的重要内容之一,主要包括流程成本的汇集及成本分析.作者对作业成本法应用于医院流程管理进行了理论探讨,并基于医院组织结构建立了医院流程作业成本模型,对医院医疗服务项目及其活动成本归集进行了论述.之后,通过实例分析,验证了医院业务流程成本分析和计算方法具有一定的实践意义.     

上海市45家医院供给的技术效率评价

医院供给的技术效率对医院运行成本和医疗服务项目的定价具有重要指导作用，通过运用随机前沿成本模型，对上海市45家医院供给的技术效率进行分析，显示不同级别医院存在着不同的低效率现象；采用多元回归统计方法，显示医疗收入占医院总收入的比例、医院总人数及卫技人员所占医院总人数的比例、医院所在区域、床位使用率、上级拨款等因素造成医院的低效率。在此基础上提出了相应的对策建议。     

价值链引导下的医院成本管理探讨

医疗卫生体制改革把医疗卫生机构推向市场,在市场的大浪淘沙下,医院步履艰难。该文通过分析医院战略发展的背景、医院成本管理理念的转变,提出价值链引导下的医院成本管理方法,该方法从时间、空间、多维度为适应市场环境,谋求战略发展对医院进行内部成本管理,其结果就是达到优化成本管理流程,最大限度地降低医疗成本和促进医疗活动价值的增值,它是一种全新的具有时代价值的成本管理方法。     

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.     

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.     

Assessing occupational and environmental exposure

Exposure assessment is a poorly understood component of the science of epidemiology. The relationship between exposure to chemicals and ill-health outcomes is often calculated using crude exposure measures such as ever/never exposed or duration. When investigating subtle effects, exposures need to be characterized much more fully in terms of intensity, frequency, duration and route. While occupational exposures tend to be much greater than those experienced from the wider environment there is a need to remember that, for many chemicals, exposure can occur occupationally, environmentally and through consumer use of products containing the material of interest. Inhalation exposure has generally been the traditional focus for most epidemiological investigations but there is now growing awareness of the importance of the dermal and ingested routes of contact and internalization. Quantification of the exposure also needs to be related to a biological mechanism of action and exposure metrics need to be selected accordingly. Occupational exposures can generally be measured using simple well-validated techniques. Environmental exposures require much more sensitive instruments and are more difficult to assess. Exposure modelling, particularly for the environmental fate of chemicals has undergone many recent developments and Monte Carlo techniques can be used to characterize model uncertainty and variability. This approach to exposure assessment can now be used in the setting of the wider environment and will enable a far better understanding of the relationship between exposure and disease.     

Mercury toxicity due to the smelting of placer gold recovered by mercury amalgam

A 19-year-old man developed tremor in both hands and fatigue after starting work at a placer gold mine where he was exposed to mercury-gold amalgam. Examination revealed an intention tremor, dysdiadochokinesis and mild rigidity. The 24-h urinary mercury concentration reached a peak of 715 nmol/l (143 ug/l) shortly before the clinical examination, after which he was removed from working in the gold room [Mercury No. Adverse Effect Level: 250 nmol/l (50 ug/l)]. On review 7 weeks later his tremor had almost resolved and the dysdiadochokinesis and rigidity had gone. The 24-h urinary mercury concentration had fallen to 160 nmol/l (32 ug/l). The principal exposure to mercury was considered to be the smelting of retorted gold with previously unrecognized residual mercury in it. The peak air concentration of mercury vapour during gold smelting was 0.533 mg/m3 (Mercury Vapour ACGIH TLV: 0.05 mg/m3 TWA). Several engineering and procedural controls were instituted. This episode occurred at another mine site, unrelated to Mount Isa Mines Limited.     

How Adults with Acquired Brain Damage Perceive Computer Training as a Rehabilitation Tool: A Focus-group Study

The aim of this study was to explore and describe how adult outpatients with acquired brain damage and referred to occupational therapy perceive computer training with the RehaCom programs, in order to evaluate the method of treatment as a tool in the rehabilitation of persons with cognitive disorders. By using focus-group discussions as a qualitative method of research when analysing the result, five themes with corresponding categories emerged, describing a development of understanding and learning about capacities. Themes describing how the participants could apply strategies to overcome shortcomings in daily occupations and the therapeutic role of the occupational therapist were identified as well. The result shows that a computer training program such as RehaCom can be used as an educational tool, for example, to guide a person who is trying to adopt compensatory strategies to avoid overload by taking pauses. It was found that anything the participants learned was also applicable to occupational performance in daily life.