基于平衡计分卡和加权TOPSIS法对医院临床科室的绩效评价

目的通过运用平衡计分卡结合加权的TOPSIS方法对合肥市某医院的临床科室的绩效水平进行综合评价,以期为医院的绩效考核工作提供一个有效的方式借鉴。方法在调查大量相关文献的基础上,采用专家咨询法根据平衡计分卡的4个维度建立医院绩效评价指标体系,运用SAS软件通过加权TOPSIS法对收集到的医院临床科室指标数据进行综合排序。结果①经过两轮筛选最终确定了4个一级,12个二级指标的临床科室绩效评价指标体系。②得出各个临床科室的综合绩效排序结果。其中妇产科的绩效水平最高,C值为0.82293,而神经外科的绩效水平是最低的,C值等于0.34414。这与该医院的实际绩效运行情况基本相符。结论平衡计分卡和加权TOPSIS法对医院临床科室进行绩效评价的结果是准确有效的,可以广泛应用于医院及其临床科室的绩效评价工作。     

基于平衡计分卡的新型农村合作医疗成本控制评价指标体系的建立

目的 建立基于平衡计分卡(balanced scorecard,BSC)的新型农村合作医疗(新农合)成本控制评价指标体系.方法 以平衡计分卡的基本理论为指导,采用SWOT分析法、关键绩效指标法、德尔菲专家咨询法和层次分析法,建立指标体系并确定各级指标权重,并采用加权综合指数法对重庆2个区情况进行综合评价.结果 构建了一套科学、实用的新农合平衡计分卡成本控制绩效评价指标体系.结论 平衡计分卡从多个维度评价新农合成本控制情况,有利于新农合工作发现不足之处,并在今后的管理中总结经验弥补不足.     

构建医院绩效考核指标体系

目的通过考核指标及考核体系的建立;实现医疗机构的绩效评价,并可以作为绩效分配的依据。方法采用资料收集方法、成熟的平衡计分卡法、德尔非法等原理建立与医院战略相关的绩效考核指标体系。结果构建了医院绩效考核指标体系,建立了与医院平衡计分卡相关的科室平衡计分卡和岗位平衡计分卡。结论为国内医院绩效考核提供一个可借鉴的模式。     

浅谈平衡计分卡在医院目标管理与绩效考核体系中的运用

本文所探讨的内容主要是如何利用平衡计分卡将医院的长期发展战略目标逐层分解转化为各种具体的相互平衡的绩效考核指标体系。并对这些指标的实现状况进行不同时段的考核,从而为战略目标的完成建立起可靠的执行基础的绩效管理体系。本文通过五个步骤具体阐述了平衡计分卡这一理论在我院的战略实施与绩效管理方面的具体运用。     

模糊综合评价法在医院科室绩效考核中的应用

目的用模糊综合评价法评估医院科室绩效。方法对某医院科室绩效考核中效率指标、质量指标、发展指标、经营指标、社会效益指标等5个方面的内容进行讨论分析,结合平衡计分卡原理和专家咨询的方法,确定了各维度指标的权重,利用模糊综合评价法计算出各维度的模糊隶属度,建立矩阵,分析评价结果。结果利用该模型计算某医院科室整体绩效考核隶属度47%的比例为"好",35%为"一般",18%为"差",根据最大隶属度可以确定某医院科室绩效考核综合评价等级为"好"。结论采用多级模糊综合评价方法构建的绩效考核评估模型,具有相对客观性和合理性,能较好地解决科室绩效考核中多个指标模糊性较强的综合问题,在实际应用中,评价结果与实际考核结果一致。     

湖南省卫生事业发展水平的综合评价

目的: 建立卫生事业发展的综合评价体系,并利用该体系评价湖南省2008-2009年卫生事业发展在中部8省份中的水平,为卫生管理决策提供依据。方法: 综合评价指标体系的建立分别采用专家咨询法调查卫生事业发展的备选指标体系、界值法筛选指标、秩和比法确定指标权重,应用加权TOPSIS法评价中部8省份卫生事业发展状况。结果: 专家咨询问卷的克朗巴赫α系数为0.884,表面效度和内容效度较好。专家积极系数为93.75%,权威系数为0.8117,专家协调系数为0.31。建立了包括3个一级指标、10个二级指标和52个三级指标的综合评价体系。综合评价结果显示:湖南省2008,2009年分别在中部8省份中排名第7和第6名。结论: 建立的综合评价体系可靠性较高。湖南省卫生事业发展在中部8省份中处于较落后地位。     

基于TOPSIS法和灰色关联分析法的临床科室业务运营绩效评价研究

目的 综合运用TOPSIS法和灰色关联分析法对临床科室业务运营绩效进行分析,为临床科室业务运营绩效综合评价提供方法参考。方法 运用文献研究、专家访谈等方法确定临床科室业务运营绩效评价指标体系,运用TOPSIS法对2015年1月1日-2019年12月31日期间5个年度的65个指标进行业务运营绩效分析评价,运用灰色关联分析法对其影响因素进行分析。结果 TOPSIS法分析结果显示,2015年-2019年该临床科室的Ci值分别是0.2436、0.2816、0.5349、0.7137、0.7117,业务运营绩效整体呈上升趋势。灰色关联度分析结果显示,影响该科室业务运营绩效的前5个因素分别是次均住院费用、介入手术台数、平均住院日、出院人数、省外患者占比,其灰色关联度分别是0.6805、0.6794、0.6682、0.6529、0.6459;后2个因素分别是次均门诊费用、当日出院再入院率,其灰色关联度分别是0.5742、0.6075。结论 TOPSIS法联合灰色关联分析法能够有效综合评价临床科室业务运营绩效,判别主要影响因素,并为进一步改善业务运营绩效指明方向。     

四种综合评价方法在广西某三级甲等医院科研绩效评价中的应用

摘要目的：应用四种常用的综合评价方法对广西某三甲医院科研绩效进行评价,探讨这些综合评价方法在医院科研绩效评价中的科学性和实用性。方法：选择5个用于评价医院科研绩效的指标,通过专家打分赋予各层指标相应权重,各项指标按照权重系数最低的分指标进行折算,最终采用综合指数法、加权密切值法、加权秩和比法和加权TOPSIS法对该院2007—2012年科研绩效进行综合评价,并计算四种方法的相关程度。结果：四种方法评价结果高度相关,通过计算四种方法评分值的算术均数,得到组合评分值及排序结果,2012年的科研绩效组合评分值为1．080,质量最好;2007年的科研绩效组合评分值为0．034,质量最差。结论：四种评价方法各具特色,都具有一定的客观性和实用性,联合应用更能切合该院科研绩效实际。     

基于平衡计分卡的临床医师绩效考核指标体系设计探讨

综合性医院的绩效考核与绩效分配既是关系到医护人员切身利益且最直接、最敏感的工作,也是推动医院各项工作的杠杆。以平衡计分卡的理论为基础,对考核对象临床医师进行分类,并对平衡计分卡的三个关键组成部分——考核指标、目标值与权重的确定进行探讨,指出绩效考核目的要明确,方法要契合实际,指标要不断改进,从而建立有效的临床医师绩效考核指标体系。     

用平衡记分卡建立护士岗位绩效指标的研究与应用

目的：借鉴平衡记分卡的理念,结合我院护理工作实际,建立科学、合理的护士绩效考核指标体系。方法：运用德尔菲法,通过3轮专家咨询和专家访谈,从顾客维度、业务流程、学习成长及成本效率4个方面建立绩效考核指标体系并赋予考核指标权重。结果：构建了平衡计分卡护士绩效评价指标体系中细化、量化的4个一级指标,9个二级指标,39个三级指标,使平衡记分卡绩效考核更加深入。结论：平衡记分卡指标体系的构建,具有科学性、实用性,可调动护理人员工作积极性,提高病人满意度和护理工作质量,提高护理管理效能。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.