某院床位带组医生岗位核定研究

目的探讨核定岗位数与考核床位数、床均工作量以及病例组合指数3个因素之间的相互关系,进而探寻床位带组医生岗位核定的科学方法。方法运用多元线性回归进行分析及预测。结果科学预测了各科室床位带组医生岗位数。结论床位带组医生制度的实施,有利于合理配置科室岗位,有利于充分调动医生积极性。但岗位核定也应随科室床位数、床均工作量及病例组合指数的变动而调整。     

基于超效率DEA模型的外科主诊医师组手术投入产出效率评价

目的 分析各外科主诊医师组手术投入产出相对效率，为提升主诊组手术效率提供参考依据。方法 将2021年1月1日—12月31日的40个外科主诊医师组作为决策单元，运用超效率数据包络分析（Data Envelopment Analysis,DEA）及灰色关联分析对其手术投入产出效率进行评价及分析。结果 40个外科主诊医师组的DEA综合技术效率均值为0.620 8，纯技术效率均值为0.775 1，规模效率均值为0.802 0，仅3个主诊医师组达到DEA有效；其中，主诊医师组开放床位数是影响手术超效率值的主要因素。结论 医院外科主诊医师组手术效率总体水平偏低，非DEA有效主诊医师组存在投入冗余或产出不足，建议医疗机构适时优化主诊组医疗资源配置，加强手术绩效管理，提高手术产出。     

重庆市重点行业744家企业工作场所噪声作业分级结果与分析

依据《工作场所职业病危害作业分级 第4部分：噪声》（GBZ/T 229.4—2012）对2021年重庆市重点行业744家企业中2 607个接噪岗位进行噪声危害作业分级。结果显示，噪声作业I~Ⅳ级岗位分别占24.47%、8.13%、3.15%、0.73%。其中，非金属矿物制品业噪声作业I级、Ⅱ级岗位数在各噪声作业分级总岗位数占比均最高，分别为21.63%（138/638）、35.85%（76/212）；非金属矿采选业噪声作业Ⅲ级、Ⅳ级岗位数占比最高，分别为40.24%（33/82）、47.37%（9/19）；不同行业间噪声作业分级差异有统计学意义（P<0.05）。噪声作业Ⅳ级岗位主要为非金属矿采选业中破碎、凿岩、穿孔、其他岗位，非金属矿物制品业中切割、破碎、其他岗位及汽车制造业中冲压岗位。重庆市重点行业工作场所噪声危害作业分级以I级为主，整体控制较好，但仍存在Ⅲ级、Ⅳ级岗位，企业应采取工程控制措施和职业防护设施进行整改和治理。     

基于DRG的三级公立医院主诊医师医疗服务绩效评价研究

目的 以清华大学附属北京清华长庚医院骨科为例，结合三级公立医院绩效评价指标，构建基于疾病诊断相关分组（DRG）的三级公立医院主诊医师医疗服务绩效评价指标，并采用多种综合评价方法进行实证研究，为三级公立医院及科室管理提供参考。方法 通过医院年度报表获取骨科12名主诊医师2021年医疗服务绩效指标数据，运用TOPSIS法、秩和比法和综合指数法对主诊医师绩效进行综合评价，并基于以上3种方法评价结果，采用Copeland法进行组合排序。结果 评价结果显示，主诊医师C、F的医疗服务绩效处于前3名行列，B、E、G3人的医疗服务绩效则相对较差；但中间名次的主诊医师排序还是会因为评价方法的不同而存在差异。结论 结合三级公立医院绩效评价指标，构建基于DRG的三级公立医院主诊医师医疗服务绩效评价指标体系，并采用多种评价方法进行实证研究，可弥补单一评价方法的片面性，使得结果更加客观、科学和公正。     

某三甲医院外科主诊医师绩效评价指标体系与效度分析

目的 建立三级综合医院外科主诊医师的医疗绩效评价指标体系和评价方式。方法 运用德尔菲法确定外科主诊医师医疗绩效评价指标：门诊量、手术量、四级手术占比、手术时长、非计划再手术发生率、CMI、DRG组数、时间消耗指数。对评价指标体系进行效度分析,计算各医师分值后由专家组对结果进行评价。结果 指标体系具有良好的内容效度和结构效度,分值整体情况符合专家组的主观评价。结论 得出的指标体系和评价方法能有效评价外科主诊医师的医疗工作绩效。     

BP神经网络模型的原理及在心理学领域的应用

人工神经网络（artificial neural networks，ANN）是一门涉及生物、电子、计算机、数学和物理等的交叉学科，它是机器模拟人脑智能活动的杰出代表。根据学习方法（算法）的不同，可以构成不同的网络。目前，已发展了几十种神经网络，例如连接型网络模型、玻尔茨曼机模型、多层感知机模型和自组织网络模型等。其中，应用最为广泛的是多层感知机神经网络，多层感知机神经网络的研究始于20世纪50年代，但一直进展不大。直到1985年，Rumelhart等人提出了误差反向传递学习算法（BP算法），才引起了人们的重视，掀起了研究神经网络的热潮。     

基于主诊医师负责制的住院绩效考核模式探讨

目的 建立主诊医师负责制下的住院绩效分配新模式,以适应医药分开改革的新要求.方法 探索基于医疗成果产出的岗位绩效管理考核和分配新制度,重点激励各主诊医师组医疗产出的工作量和工作难度,促使各主诊医师组增加服务量、提高技术水平和诊治疾病的难度.结果 以某科室各主诊医师组为例,从科室管理、团队建设、学科发展、工作效率等角度分析医改前后的转变.结论 重点激励分配制度,逐步被医务人员所接受,并取得较为明显的成效.     

应用中断时间序列分析主诊医师考评机制对床位周转效率的影响△

目的：研究推行主诊医师考评机制对床位周转效率的干预效果。方法：采用中断时间序列（Interrupted Time-Series,ITS）对天津某专科医院推行主诊医师考评机制后床位周转率变化进行分析。结果：推行主诊医师考评机制后床位周转率呈明显上升趋势,每年提升2.25人次,比主诊医师考评机制推行前每年涨幅增加1.40人次。结论：推行主诊医师考评机制对床位周转效率有显著的提升效果。     

大型综合性医院主诊医师负责制绩效考核分析及改进建议

主诊医师负责制又称医疗小组组长负责制，其核心是由一个主诊医师带领2—3名主治或住院医师组成一个治疗组，全面负责病人的门诊、住院、手术、出院及院后随访等工作。实行主诊医师负责制的关键是制定科学、规范、合理、实用的绩效考核方案。本文根据大型综合性医院实行主诊医师负责制绩效考核的实践，讨论其优点及难点所在，进一步完善主诊医师考核办法，并为相关管理和决策提供参考。     

砖瓦制造业粉尘职业健康风险评估技术应用研究

目的 运用四种风险评估模型对砖瓦制造业粉尘职业健康风险进行评估,为砖瓦制造业重点职业病危害建立风险评估提供方法依据。方法 以四川省18家典型砖瓦制造企业71个接尘岗位为对象,通过职业卫生调查、粉尘检测与接触评估,运用改良后定量分级法、综合指数法、国际采矿与金属委员会(ICMM)职业健康风险评估定量法、职业危害风险指数法四种风险评估方法,评估接尘岗位的健康风险。结果 砖瓦制造接尘岗位职业健康风险结果分别为：改良后定量分级法风险等级范围为0～Ⅲ级,以Ⅰ级为主(接尘岗位数64个,占90.1%);综合指数法主要为中等风险(接尘岗位数55个,占77.5%)和高风险(接尘岗位数16个,占22.5%);ICMM定量法：主要为高风险(接尘岗位数46个,占64.8%)、非常高风险(接尘岗位数18,占比25.4%)和不可容忍风险(接尘岗位数7个,占9.9%);职业危害风险指数法以无危害(接尘岗位数33个,占46.5%)和轻度危害(接尘岗位数30个,占比42.3%)为主。综合指数法和ICMM定量法的风险结果一致性较好,方法间相互验证了风险结果的可信度与稳定性,其他方法评估结果间存在不稳定性。结论 四种风险评...     

Adverse drug reactions causing hospital admission in an elderly population: experience with a decision algorithm

An adverse drug reaction (ADR) decision algorithm was used in the review of 100 consecutive hospital admissions of elderly patients cared for by family physicians. The algorithm is a valid methodologic alternative to using pharmacological experts for verification of an ADR. In this study, the algorithm was easily applied by family physicians, and the results were similar to those reported by expert clinical pharmacologists. Nine percent of our elderly patients' hospital admissions were caused by ADRs that were due to usual doses of medications commonly prescribed for elderly patients. Average age of patients and number of medications were similar for persons with and without ADRs. The algorithm can be useful to physicians investigating ADRs for clinical research, physician education, quality assurance, and improved patient care.     

Impact of physician telephone management of nursing home residents before the initial assessment: a pilot study

OBJECTIVE: To describe physician telephone management of newly admitted nursing home residents before direct evaluation by the physician, and the effect on resident outcomes. DESIGN: Retrospective chart review of 111 consecutive discharge records from two proprietary community nursing homes in Baltimore, Maryland in 1999. MEASUREMENTS: Data regarding the admission process were collected, with an emphasis on physician telephone orders at admission and all subsequent telephone orders before the first physician visit. Physicians were categorized as attending physicians or on-call physicians. Unexpected outcomes defined as an unplanned admission to an acute hospital or an unanticipated death within 14 days of admission to the nursing home were identified. The relationships among resident, physician, and admission characteristics and unexpected outcomes were analyzed. RESULTS: Most residents (97 of 111 (87%)) were admitted from an acute hospital, and the remaining 13% were admitted from home or another nursing home. An attending physician confirmed admission orders for 87 of 111 (78%) residents, and an on-call physician confirmed admission orders for the remainder. Physicians changed medications at the time of admission, as compared with preadmission medications, in 58 of 111 (52%) residents and ordered laboratory studies or radiographs in 59 of 111 (53%). On-call physicians were just as likely to make both types of changes as attending physicians. In the time interval after the initial telephone contact but before the first physician visit, medication changes were made in 35 of 111 (32%) residents and testing was ordered in 16 of 111 (14%). Nineteen of 111 (17%) residents were either readmitted to the hospital or died within 14 days of admission to the nursing home. These unexpected outcomes were statistically less likely to occur in the group of residents for whom physicians made medication changes at the time of admission as compared to the group for whom no medication changes were made [6 of 58 (10%) versus 13 of 53 (25%), P = 0.04, respectively], and in the group for whom tests were ordered at the time of admission as compared to not ordered [4 of 59 (7%) versus 15 of 51 (29%), P = 0.002, respectively]. There were no differences in the likelihood of unexpected outcomes when physicians made medication changes or ordered tests after the time of admission but before the first physician visit. CONCLUSIONS: In this study, physicians made adjustments in medications and ordered tests for newly admitted nursing home patients before seeing the resident in the majority of cases. Unexpected outcomes including readmission to the hospital or death within 14 days of admission were less common among those residents when such changes were made at the time of admission. Further studies are needed to identify those changes as well as those resident and physician characteristics that might lead to improved outcomes.     

Physician-delivered births in Washington State, 1978: geographic patterns.

Linkage of birth certificate and physician survey data was used to analyze characteristics of physicians attending deliveries in Washington State in 1978. This analysis revealed substantial differences in attendant characteristics between rural and urban areas. The more urban areas were characterized by a higher proportion of births delivered by obstetrical specialists and a higher average number of births/physician. These results are briefly discussed in terms of supply and accessibility of physicians in several different rural-urban classifications.     

“pop-out” method of levonorgestrel implant removal

The “pop-out” technique is a method of levonorgestrel implant removal that uses digital pressure to direct implants through a small skin incision. This technique was developed, theoretically, to cause less bruising and patient discomfort by avoiding the use of instruments. The pop-out technique is the primary method used for levonorgestrel implant removal in the Magee-Womens Hospital resident clinic. We performed a retrospective analysis of levonorgestrel implant removals performed between July 1, 1995, and December 31, 1998. Of the 168 removals included in this analysis, 38 were performed by one of two attending physicians, and 130 were performed by the residents with attending supervision. The average time for removal was 12 ± 5 min (range 2.25–27 min) when the “pop-out” method could be used to remove all six implants, and 14 ± 7 min (range 2.25–59 min) for all removals. The removal time for residents was inversely proportional to the anticipated level of difficulty of the removal and to the number of previous removals performed. The removal time was significantly faster when residents were supervised by one of the attending physicians as compared with the other attending physician. Only 0.7% (7/1,008) of levonorgestrel implants were fragmented during removal. This review shows that the “pop-out” method is a reasonable alternative to other proposed methods of primary implant removal. The difference in the level of expertise of the attending physician may significantly influence removal time when training clinicians in levonorgestrel implant removal.     

Physician practice size and variations in treatments and outcomes: evidence from Medicare patients with AMI

Little is known about the relationships between physician practice size and patient treatments or outcomes. We examined whether the practice size of attending physicians was related to within-hospital differences in care for Medicare patients with acute myocardial infarction (AMI). We found that patients treated by solo physicians were less likely to receive cardiac catheterization and angioplasty within a day of admission and more likely to die than other patients in the same hospital, even after a number of patient and physician characteristics were taken into account. These differences suggest that solo practitioners are less likely to follow guidelines calling for quick use of angioplasty.     

Understanding birthing mode decision making using artificial neural networks.

BACKGROUND: This study examined obstetricians' decisions to perform or not to perform cesarean sections. The aim was to determine whether an artificial neural network could be constructed to accurately and reliably predict the birthing mode decisions of expert clinicians and to elucidate which factors were most important in deciding the birth mode. METHODS: Mothers with singleton, live births who were privately insured, nonclinic, non-Medicaid patients at a major tertiary care private hospital were included in the study (N = 1508). These mothers were patients of 2 physician groups: a 7-obstetrician multispecialtygroup practice and a physician group of 79 independently practicing obstetricians affiliated with the same hospital. A feedforward, multilayer artificial neural network (ANN) was developed and trained. It was then tested and optimized until the most parsimonious network was identified that retained a similar level of predictive power and classification accuracy. The performance of this network was further optimized using the methods of receiver operating characteristic (ROC) analysis and information theory to find the cutoff that maximized the information gain. The performance of the final ANN at this cutoff was measured using sensitivity, specificity, classification accuracy, area under the ROC curve, and maximum information gain. RESULTS: The final neural network had excellent predictive accuracy for the birthing mode (classification accuracy = 83.5%; area under the ROC curve = 0.924; maximum information = 40.4% of a perfect diagnostic test). CONCLUSION: This study demonstrated that a properly optimized ANN is able to accurately predict the birthing mode decisions of expert clinicians. In addition to previously identified clinical factors (cephalopelvic disproportion, maternal medical condition necessitating a cesarean section, arrest of labor, malpresentation of the baby, fetal distress, andfailed induction), nonclinical factors such as the mothers' views on birthing mode were also found to be important in determining the birthing mode.     

The adequacy of Papanicolaou smears as performed by family physicians and obstetrician-gynecologists

BACKGROUND: Little is known about the quality of Papanicolaou (Pap) smears performed by family physicians and obstetrician-gynecologists. METHODS: Using hospital archival records of Pap smears performed from 1995 to 1997, we compared the quality of Pap smear sampling and the rate of detection of significant cytologic abnormalities by family physicians and obstetrician-gynecologists. Using hierarchic logistic regression, we examined the relationship between physician specialty and Pap smear reports, controlling for patient age and socioeconomic position, multiple Pap smears performed by the same clinician, and physician attending status. RESULTS: A total of 34,916 Pap smears performed by 130 family physicians and 88 obstetrician-gynecologist residents and attending physicians were included in the analysis. There were no statistically significant differences by specialty in the rates of unsatisfactory reports (adjusted odds ratio [AOR] = 0.82; 95% confidence interval [CI], 0.48 - 1.38), satisfactory but limited reports (AOR = 1.16; 95% CI, 0.93 - 1.48), or detection rates of significant cytologic abnormalities (AOR = 0.83; 95% CI, 0.66 - 1.04). However, family physicians submitted more Pap smears with an absent endocervical component (AOR = 1.50; 95% CI, 1.07 - 2.11). CONCLUSIONS: These findings show no significant differences by specialty in Pap smear quality as measured by rates of unsatisfactory and satisfactory but limited reports, or detection of cytologic abnormalities. The finding of higher rates of absent endocervical cells, if replicated by further study, may suggest the need for improved training of family physicians in sampling the endocervix.     

Obstetric care in family practice residencies: a 5-year follow-up survey

BACKGROUND: The percentage of family physicians delivering babies decreased from 46% in 1978 to 32% in 1992. Some family practice leaders predicted that, by the turn of the century, training for family practice obstetrics would focus primarily on those planning to work in remote or rural settings. A 1993 study found three primary factors associated with an increased incidence of future maternity care. In 1997 the Residency Review Commission (RRC) stipulated that all family practice residencies have at least 1 family physician serve as an intrapartum attending physician for family practice resident deliveries. METHODS: Using an instrument similar to that used in 1993, we surveyed the directors of 462 family practice residencies in the United States. Sixty-four percent (295) of the program directors responded to one of two mailings. RESULTS: Compared with the survey published in 1993, program directors estimated a 16% increase in the number of residents who included obstetrics in their first practice after residency. Factors associated with increased obstetric participation included having only family physician faculty supervise uncomplicated deliveries and having family physician faculty who could perform other perinatal procedures. Programs that had 4 or more family physician faculty doing obstetrics and those that had more than 10 deliveries per month also produced more physicians who provided maternity care. Fifty-three percent of residencies that did not have family physician faculty attending deliveries before 1997 now meet this RRC requirement. CONCLUSIONS: This study shows that, according to their program directors' estimates, more family practice residents are including obstetrics in their first practice after residency compared with 5 years ago. The new RRC regulation was associated with more than 50% of previously noncompliant programs adding or retraining faculty who could attend resident deliveries within 12 months of the inception of the new policy.     

A performance comparison: USMG-FMG attending physicians.

To determine whether patterns of differences in performance exist between United States Medical Graduate and Foreign Medical Graduate attending Physicians, two types of inpatient hospital audits (Payne Process Audit and the Joint Committee on Accreditation of Hospitals' Performance Evaluation Program-P.E.P. Audit) were conducted in 22 Maryland and Pennsylvania non-federal, short-term hospitals. A total of 6,980 medical records were abstracted from eight diagnostic categories for 1,321 attending physicians; 985 of which were USMGs and 331 were FMGs. The results from both audits indicate that while there is evidence of a strong hospital-type of physician interaction for many of the diagnoses, there was no significant overall difference in performance between USMG and FMG attending physicians. The largest and most consistent differences in physician performance were associated with hospital characteristics, not physician characteristics.     

Which values do attending physicians try to pass on to house officers?

CONTEXT: Professional development in medicine includes the acquisition of values and attitudes which are fundamental to the role of the physician. Little is known about which values and attitudes attending physicians emphasize in their teaching of medical trainees to help them develop professionally. OBJECTIVE: To determine the values and attitudes which attending physicians try to pass on to residents in order to encourage their professional development. DESIGN: Cross-sectional study using a mailed survey. SETTING: Four university-affiliated teaching hospitals. SUBJECTS: Attending physicians with residency-level teaching responsibilities. MEASUREMENTS: The self-reported single value or attitude that attending physicians try to pass on to house officers. RESULTS: Of the 341 attending physicians who returned a completed questionnaire, 265 (78%) shared the single value or attitude they try to pass on to residents. The four main categories into which more than 95% of responses could be categorized were: (i) caring, (ii) respect, (iii) communication and (iv) integrity. There were no statistically significant differences between the responses given by attending physicians who had been named as excellent role models and their colleagues who had not been so named. CONCLUSIONS: Attending physicians attempt to pass on values and attitudes they consider important for the professional development of medical trainees. Future research might focus on optimal ways to teach these qualities to medical learners.