2012年中国民营医院百强医院发展特点分析

通过对中国民营医院百强的医院规模、医疗技术、品牌形象三个维度的数据分析,了解中国民营医院快速发展现状,其发展状况呈现以下几个特征:民营医院主要集中分布在粤苏地区;民营医院的来源多元化,其中改制医院占36%;民营医院与公立医院的竞争高度同质化;民营医院的学科建设还处于起步阶段。     

2009—2019年广州市公立医院与民营医院运行效率比较及影响因素分析

目的 通过测算和比较新医改十年来广州市公立医院和民营医院的运行效率,以期为卫生行政部门和医院管理部门优化医院管理提供决策依据。方法 运用数据包络分析方法(DEA模型)对2009—2019年广州市公立医院和民营医院的运行效率进行测算和比较,通过构建Tobit模型分别对公立医院和民营医院的效率值进行影响因素分析。结果 DEA效率比较发现：新医改十年来,公立医院的综合技术效率和规模效率要普遍优于民营医院,纯技术效率与民营医院相差不大;DEA效率影响因素发现：医师年均负担诊疗人次和医院总支出这两个因素对公立医院和民营医院效率均有显著正向影响,其他因素在不同模型中的显著性存在较大差异。结论 公立医院和民营医院都应根据实际情况合理调整自身规模与结构;积极推动鼓励民营医院发展的政策予以落实,进一步完善民营医院发展环境;公立医院应严格管控医院的药占比,并提高医师劳务技术价值;社会应重视护理人员的培养,扭转医护比例倒置问题。     

二孩政策和PAC后不同性质的计划生育服务机构手术情况分析

目的了解实施二孩政策和流产后关爱(PAC)后对计划生育服务机构的影响,指导今后的计划生育服务。方法采用描述性分析法对上海市徐汇区8家公办医院、5家民营医院2016-2017年的计划生育手术资料进行分析。结果2017年上海市徐汇区总手术量、人工流产总数、药物流产、取环术均较2016年下降,避孕节育手术总体呈下降趋势,公办和民营医院放环和皮埋结扎量均上升,民营医院人工流产上升幅度大,本市和外地已婚女性、外地未婚女性中选择民营医院手术人数增加。结论上海市徐汇区公办医院手术量虽有下降,但仍然是计生手术的主力军,民营医院是目前医疗机构的重要补充,民营医院人工流产数上升幅度大,要加大对民营医疗机构的监管力度,加强PAC咨询能力,学习新技术,规范服务流程,重视节假日手术安全。     

基于数据包络分析的某区民营医院效率评价

目的对天津市某区民营医院效率进行评价,为提高民营医院效率提出有效建议。方法采用文献优选法确定评价指标,运用数据包络分析(DEA)模型对投入产出指标进行分析。结果 13所民营医院中8所医院DEA有效,5所医院非DEA有效,5所非DEA有效的医院规模效率均小于1;2010—2012年,13所医院的全要素生产率平均降低18.4%,技术进步降低19.4%,技术效率提高1.3%。结论民营医院存在效率低下的问题,主要原因是规模不经济和技术投入不足。     

改善政策环境支持民营医院的发展

目的了解重庆地区民营医院的现状，以探讨支持民营医院发展的政策环境。方法采用对政府职能部门的走访；重点民营医院的考察及对民营医院就诊病人的随机问卷调查。结合对国内几家知名民营医院的相关资料进行对比的调查方法。对3个卫生职能管理部门，7家民营医院相关责任人，122个病人进行了调查。结果目前各民营医院的管理无专门的与之相配套的政策法规。多数人对民营医院持赞成和肯定态度，民营医院有其存在的需要和环境。各民营医院反映的主要问题：①对待不公平（85．7％）；②税收物价（57．1％）；③管理问题占所调查医院的60％；④媒体公正报道（42．8％）等。结论根据调查结果，笔者提出建议以改善政策环境支持民营医院的发展。     

山东省民营与公立医院医疗质量管理典型调查比较分析

目的 通过对民营医院与公立医院的医疗质量管理情况进行比较分析,找出2类医院存在的不足及它们之间的差别,并提出改进建议。方法 采用方差分析及Kruskal-Wallis H检验、SNK法及Games-Howell法,对民营医院、公立二级医院和公立三级医院之间的典型调查数据进行比较分析。结果 民营医院与公立二级医院相比,除2个方面单项得分无统计学差异外,其余6个方面单项得分及总得分均有统计学差异;民营医院与公立三级医院相比,8个方面单项得分及总得分均有统计学差异;公立二级医院与公立三级医院相比,只有“各医院总得分”1项有统计学差异,8个方面单项得分均无统计学差异。结论 民营和公立医院在医疗质量管理方面都存在不足,但民营医院总体上差于公立医院;民营医院管理水平参差不齐,也有部分民营医院管理较规范。应加强对医院,特别是民营医院的监管,继续完善医院监督检查制度,建立完善医疗质量管理信息公开制度。     

通过医患满意度分析谈民营医院发展对策

目的:通过问卷和访谈的方法调查和分析成都市的9家民营医院就诊患者和员工的满意度,旨在为促进民营医院的发展提供参考。结果:患者对民营医院服务态度和质量评价较高,对收费和基本设施满意度较低;员工认为医院的管理环境和个人环境均有不尽如人意的地方。建议:民营医院在价格上让利于民,加强人力资源建设和自身管理,多渠道融资并争取政府支持。     

国有与民营医院工作场所暴力情况比较

目的了解河北省唐山市国有医院和民营医院工作场所暴力的流行特征并比较其特点。方法采用整群抽样方法 ,调查唐山市3所国有医院和5所民营医院的844名医务人员在2008年4月-2009年4月遭受工作场所暴力情况。结果国有医院工作场所暴力发生率为62.98%(314/497)高于民营医院的19.60%(68/347);国有医院与民营医院均以心理暴力为主,国有医院为46.48%,民营医院为13.55%;国有医院与民营医院暴力发生时间均以白班为主;国有医院暴力事件多发生在病房,发生率为47.92%;民营医院多发生在医办室,发生率为32.35%;国有医院和民营医院发生工作场所暴力的最主要原因分别为肇事者酗酒和患者病情无好转或自认为无好转。结论唐山市民营医院工作场所暴力发生率低于国有医院,应针对各类医院特点采取干预措施,减少医院暴力的发生。     

中国民营医院发展现状与趋势研究

采用文献分析法对我国民营医院的发展现状和趋势进行分析,结果认为我国民营医院发展速度较快,但规模偏小、医疗市场份额低,整体水平还远不具备与公立医院分庭抗衡的实力;在发展和政策支持上民营医院地区间发展不平衡,东部优于中西部;民营医院的发展面临空前大好的政策环境,以公有制医疗机构为主体,多种所有制形式与经营方式并存,公平竞争、共同发展的医疗服务体系新格局开始逐步形成.     

民营医院医院感染管理分析及改进措施

目的 对我市民营医院医院感染管理现状进行分析及提出改进措施。方法 为了规范民营医院的医疗行为，保障民营医院的健康发展，通过对我市民营医院进行调研、检查，对医院感染管理现状进行分析。结果 提出我市民营医院医院感染管理的改进措施，并帮助指导实施。结论 在医院医疗质量管理体系中医院感染管理是一个必不可少的重要环节，通过一系列医院感染管理的改进措施，使民营医院医院感染管理工作有据可依，有章可循，走向规范化、标准化和科学化管理，促进民营医院走上健康发展的道路。     

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.