用科学发展观指导医院文化建设

医院的发展离不开优秀的医院文化，医院核心竞争力的培养更需要优秀医院文化的支撑,推进医院文化建设，是现代医院树立和落实科学发展观的必然要求。     

刍议用科学发展观指导我区医院建设与发展

1985年，国家卫生部出台了以鼓励多种形式办医为重点的宏观卫生改革和以打破“大锅饭”为主要内容的医院内部运行机制改革等一系列政策，经过20年的探索实践，全国大部分地区的医院通过扩建、改建病房、装备高精尖医疗设备、扩大服务规模、改善服务条件等措施，使医院的建设与发展整体水平有了质的跃升，军队医院的发展在此阶段内也取得了长足的进步。但发展中因忽视“全面、协调、可持续”而造成的“医疗成本过高、医患关系紧张、盲目扩大规模、人力资源短缺”等问题和由此引发的“卫生资源配置不合理、政府卫生投入不足、医疗服务市场化和商业化倾向加剧、药品流通市场秩序混乱、卫生费用负担过重”等深层次矛盾的凸显，     

以科学发展观为指导推动军队医院建设全面协调发展

历史的经验昭示，军队各项建设的发展之路，都离不开党的创新理论光芒的照耀。科学发展观作为党的创新理论的最新成果，是推动我国经济社会发展长期坚持的重要指导思想，也是加强国防和军队现代化建设的重要指导方针。下面就如何运用科学发展观为指导推动军队医院建设全面协调发展谈四点初浅认识。     

按科学发展观要求创建医院先进文化

医院文化是广大医务人员在医疗服务实践中集体创造、逐步积淀的团队精神和服务理念。医院文化建设是现代医院管理的重要组成部分，创建医院先进文化对医院全面发展有着重要的现实意义。当前，确立科学发展观在医院建设中的指导地位，要高度重视医院先进文化建设。     

用科学发展观培育成长型医院

武警部队中、小型医院管理者应在管理实践中用科学发展观统领思想,摸索出一套适合自己发展的管理路径.     

加强医院文化建设促进医院全面发展

随着社会主义市场经济体制的不断完善和医疗卫生体制改革的不断深入，医院之间的竞争已从传统的设备竞争、技术竞争上升为服务竞争和文化竞争。医院要想在激烈的竞争中立于不败之地，实现快速、健康、协调发展，就要加强医院文化建设，充分发挥文化力在医院核心竞争力中的决定性作用，使医院具备可持续发展和永续的竞争能力。优秀的现代医院文化会对医院的建设与发展产生十分积极的综合作用，能够形成医院意识、优化医疗质量、提高医院管理水平，从而使医院焕发活力，增强竞争力，产生更高的社会效益和经济效益，促进医院的全面发展。本文就此谈几点看法。     

军队医院文化建设研究

医院文化是医院在发展建设过程中逐步形成的精神文明与物质文明的总和，是医院核心竞争力的关键。是医务工作者在长期的医疗经营服务过程中共同形成的，具有集体性并被全体员工所认同的群体意识及公众对医院的整体认知。虽然企业文化在我国已经有20余年的发展历史，已经具有一定的理论水平和实践能力。但是对于我国的医院来说，还是非常欠缺。     

浅谈医院文化建设

随着医疗卫生改革的进一步深入,医院必将面临日益激烈的竞争,医院如何应对挑战,谋求发展,在诸多必备的因素当中,医院文化建设占据着非常重要的地位.     

着眼军队传染病医院特点 创新医院文化建设

医院文化是在一定的民族文化传统中逐步形成的具有本医院特色的基本信念、价值理念、道德规范、规章制度、生活方式、人文环境以及与此相适应的行为方式的总和[1]。其实质是以人文为主体,以文化引导为手段,以激发医务人员的聪明才智和创造力为目的的管理方法。一所具有新型优秀文化的医院,医疗技术水平就高,服务态度就好,医德医风就正,经营管理水平就高,在社会上的形象就好。因此,新时期创新医院文化,对于加强医院现代化管理,提高医疗技术水平和经营管理水平,提高医疗质量和服务质量,提高人的素质和加强医院行风建设都具有重大的战略意义。近年来,我院用科学发展观指导医院文化建设,在建院理念中融入文化内涵,在管理机制中体现文化元素,在日常活动中贯穿文化传统,不断拓展载体,创新机制,为全面建设现代化传染病医院提供了强大的精神动力。1创新医院文化建设观念1.1树立“拼文化”的观念:医院文化代表着全体人员的理想信念、价值取向和道德准则[2],能规范和引导医务人员的自主行为,在内部产生巨大的向心力和凝聚力,并代代相传,在外部增强医院的竞争力并产生深远影响。相同级别的医院在设备力量上已无太大差异,硬件的竞争空间越来越小。文化建设已成为医院建设的最高境...     

Hepatic radiofrequency under CT-fluoroscopy guidance

PURPOSE: This study was done to assess the effectiveness and advantages of computed tomography (CT) fluoroscopy as a guide for locating and treating lesions that are not amenable to ultrasound (US) guidance, and to evaluate the CT signs of immediate technical success and the short-term results. MATERIALS AND METHODS: Over the past year, we selected 14 patients (four women and ten men; mean age 73, range 61-83 years) out of 103 candidates for hepatic radiofrequency ablation (RFA). The 14 lesions comprised seven residual tumours after combined embolisation and US-guided RFA of a large hepatocellular carcinoma (HCC), which were indistinguishable from necrosis or surrounding healthy parenchyma; two HCC nodules in locations that were inaccessible by US; five metastases (two from renal carcinoma, two from colorectal adenocarcinoma and one from lung carcinoma), of which one could not be distinguished from the surrounding healthy parenchyma on US and four were inaccessible by US. Lesion diameters were between 1.4 and 3.5 cm. The procedures were performed in the CT room with anaesthesiological assistance using a coaxial LeVeen needle electrode (14 gauge, 2-to 4-cm array diameter). Immediate technical success was evaluated by multidetector CT (MDCT), and follow-up was carried out with MDCT at 3 and 6 months and yearly thereafter. RESULTS: Immediate technical success was obtained in 13/14 patients; one case required further placement of the electrode due to incomplete ablation of a hypervascular lesion. In 2/3 metastatic lesions with portal vein supply, there were no recurrences at 3 and 6 months; in 1/3, we observed disease progression, with the appearance of additional nodules at 6 months. The two metastases with arterial supply showed no signs of recurrence at 3 months; one case developed a recurrence along the ablation margin, with the appearance of satellite nodules at 6 months. In two HCC nodules, there was immediate technical success and no recurrence at 3 and 6 months. Of the seven residual tumours of HCC, all treated with immediate technical success, we observed disease progression, with the appearance of satellite nodules at 3 months in one case, at 6 months in another and at 12 months in another; 3/7 patients were free of disease at 12-month follow-up; 1/7 died 5 months later due to causes unrelated to the procedure. CONCLUSIONS: CT fluoroscopy is overcoming the limitations of CT in locating and treating lesions with different hepatic vascularisation and those unamenable to US; furthermore, it reduces the length of the procedure, thanks to the faster and more accurate placement of the needle electrode. MDCT proved to be a reliable method in the assessment of immediate and short-term results of RFA.     

Targeted drug delivery under MRI guidance

The main goal of local drug delivery is to increase the concentration of a specific therapeutic agent in a target tissue with minimal nontarget distribution. Compared to systemic therapy, local drug delivery provides a high level of therapeutic efficacy with minimal systemic effects. The current primary imaging modality for drug delivery has been x-ray angiography, but it has major limitations including anatomical ambiguity and inability to visualize the targeted tissues. Due to these inherent problems, MR guidance has been explored as an alternative imaging modality for guiding and monitoring of drug therapy. Recently, interventional MR (XMR) systems have been implemented that have both dual x-ray and MRI capabilities in a single suite and allow for real-time interventional procedures to be performed in a clinical setting. In cases where drug delivery is required, this system provides a significant leap for catheter-based therapies. Although clinical drug delivery procedures utilizing MR guidance are still in the early stages of development and application, recent technological advances should help further promote the adoption of such procedures. This review covers the emerging techniques of drug delivery using MR guidance.     

Sciatic nerve block under fluoroscopic guidance

Sciatic nerve block under fluoroscopic guidance was performed in 17 patients. This anesthetic technique along with femoral nerve block was found to be effective in patients having unilateral femoral arteriography or occlusive arteriography of their extremities. No complication was encountered in this group of patients.     

Percutaneous nephropyelostomy under continuous real-time ultrasound guidance

Fifty-five percutaneous nephrostomies in 40 patients under ultrasound guidance are reported. Twenty-six procedures were performed using a compound scanner and 29 were performed under real-time guidance. Fifty of the 55 procedures were successful. The puncture modalities of both techniques are compared and it was concluded that only real-time guidance permits the continuous two-dimensional visual control of the procedure. It is, therefore, the safer and more precise technique for establishing a percutaneous nephrostomy.     

经皮穿刺胃造瘘和胃空肠造瘘术

目的 探讨透视引导下经皮穿刺胃造瘘术（PG）和胃空肠造瘘术（PGJ）的可行性和安全性。方法 23例吞咽困难的患者。上段食管癌10例,中段食管癌1例,咽部癌6例,球麻痹2例,脑转移瘤4例。采用美国Cook公司生产的Marx-cope PGJ套装。先经鼻饲管经鼻或经口途径置入导管后注入气体800～1000ml,至胃腔明显扩张。然后在透视引导下采用Seldinger技术将PG饲管置入胃腔内,或将PGJ饲管经胃腔、十二指肠置入空肠内。术后严密观察腹部症状和体征。随访饲管使用情况。结果 23例患者均成功完成PG术,技术成功率为100％。其中将饲管置入空肠内13例,均成功。术后出现上腹部疼痛1例,造瘘口周围感染1例,经处理后均痊愈。1例于术后第2天,因胃内容物反流出现窒息死亡。随访期间经饲管给予顺利。恶性肿瘤患者18例死亡,另3例仍在随访中,中位生存期为6．5个月。球麻痹患者1例更换新的PG饲管,另1例失访。结论 透视引导下PG和PGJ术,成功率高,并发症少,是建立长期胃肠内营养的良好途径。     

Selective renal biopsy under ultrasonic real-time guidance

A new technique for performing renal biopsy using ultrasonic real-time guidance was developed at our clinic in 1978. The puncture procedure is monitored in 2-dimensional real-time images by a mechanical sector scanner equipped with an attachment for needle guidance. The technique is called “selective renal biopsy” because tissue can be obtained selectively from any portion of the kidney. During the last 4 years, 150 such procedures have been performed on 148 patients. The success rate has been 96%. No serious complications occurred.