门诊收费系统的安全管理

介绍了门诊收费系统的主要功能、业务流程,以及为了保证门诊收费系统的正常运行和财务安全,所采用的门诊数据库服务器、历史数据库服务器和门诊备用数据库服务器的分布数据库结构,门诊收费系统软件对门诊发票、门诊退费流程和收款员交账进行有效管理和控制。门诊收费系统的应用,结合医院所制定的门诊收费规章制度,优化了门诊病人的就诊流程,规范化了医院对门诊收费的管理,取得了较好的经济效益和社会效益。     

基于Web服务的门诊医生协同工作系统研究

阐述了门诊医生工作站的功能,介绍了基于Web服务的门诊医生协同工作系统,分析了系统的技术架构。该系统基于SOA架构,采用Web服务技术,实现了门诊医生工作站与门诊挂号系统、门诊收费系统、门诊药房系统、检查／检验系统等的无缝集成,从而消除了“信息孤岛”,使门诊医生工作站与其它系统协同工作,提高了门诊医生工作站的运行效率。     

门诊患者咨询热点的调查与分析

门诊工作在医院工作中,占有非常重要的位置。近两年来,全国各医院都在加强门诊建设。特别是在门诊结构、门诊功能、门诊流程等方面,研究的比较多。本文作者为了对门诊工作进行持续质量改进,从门诊大厅的咨询工作人手,展开了门诊服务现状调查。特别关注了患者的咨询热点,并就咨询热点问题进行了讨论,提出了解决办法。     

门诊医生工作站与门诊流程改革

目的以病人为中心,减少病人在门诊等待时间,提高医疗服务质量。方法通过门诊医生工作站实施,完善门诊导诊咨询系统,进行门诊流程改革。结果优化了门诊流程,提高了门诊工作效率。结论病人在门诊各个环节滞留时间减少,病人对医院服务满意度明显提高。     

门诊多渠道收费方式现状调查与分析

概括了门诊多渠道收费方式的发展现状,对某院2013年1月1日～10月12日门诊收费资料进行分析,提出门诊多渠道收费方式的改进措施,缓解了门诊收费压力,但需进一步规范门诊收费流程,完善门诊信息化建设.     

服务于门诊运营管理的数据采集与分析系统的设计与实现

目的:设计并实现门诊运营管理数据采集与分析系统,解决门诊运营管理的信息需求.方法:分析门诊运营管理存在的主要问题,提出系统设计的基本原则,建立系统的基本框架和主要功能,并给出了系统扩展方面的方法.结果:建立了门诊运营管理系统,优化了门诊运营管理的工作模式和管理方式,解决了传统门诊运营方式的局限性.结论:门诊运营管理系统的设计与实现,能有效提高门诊运营管理的工作效率和服务质量.     

门诊护理管理现状及展望

门诊是医院工作的重要组成部分,代表医院的形象,门诊护理管理又是门诊管理的重点,本文从门诊护理管理理念、管理理论、管理模式、流程管理、特色门诊管理等方面综述了门诊护理管理的现状,并对“大门诊”的发展前景进行展望.     

综合性医院门诊服务流程管理研究

综合性医院门诊是医院面向社会的窗口,门诊医疗服务工作直接影响到医院整体竞争实力。以某院门诊相关诊疗信息和现场调研为基础,分析了目前门诊医疗服务中存在的问题,讨论了门诊运营管理中流程理念的应用,提出门诊医疗服务流程管理的重点和相关建议。     

计算机在医院门诊统计中的应用

目前,门诊统计工作大多局限于门诊的数量统计上,统计资料的收集主要从门诊挂号室和门诊医生日志两个途径而来;统计项目少而单一,不能从多角度、多方面反映门诊医疗服务质量的变化和进行医院科室间的门诊质量的比较;统计手段陈旧,门诊医疗信息的利用不高。如何提高门诊医疗统计的质量,充分发挥统计在门诊医疗质量管理中的作用,是当前门诊医疗统计工作所必须解决的紧迫问题。为此我们在这一方面做了一些尝试,研制开发了口腔医院门诊《病案首页管理与医疗统计系统》(简称《系统》)的计算机辅助管理系统,较好地解决了门诊统计工作存在的缺陷。以下简要介绍此系统在统计方面的应用。     

《医疗机构门诊质量管理暂行规定》意义解读

近年来,随着医疗卫生事业的发展,我国医疗机构门诊诊疗服务量日益增加,服务范围逐渐拓展,服务内涵更加丰富。《医疗机构门诊质量管理暂行规定》的出台,使我国门诊质量管理有了纲领性的指导文件,开启了医院管理特别是门诊管理的新时代。规定首次明确门诊质量管理工作体系和机制,定义了各类常用概念并对门诊质量管理提出了系统性要求。规定的出台引起各级医疗机构对门诊管理工作的重视,对推动门诊管理的规范化、科学化、同质化及树立优质标杆起到了积极的引导作用。     

中山市儿童期超重对青少年肥胖影响的队列研究

目的 了解广东省中山市7~18岁儿童青少年肥胖的发病率,探讨儿童期超重对青少年肥胖的影响。方法 于2005年对中山市一年级小学生体检测量身高、体重,连续随访10年(1次/年),共有2 188名中山市小学一年级到高中一年级学生作为回顾性队列研究对象。使用2018年颁布的《学龄儿童青少年超重与肥胖筛查》 (WS/T 586-2018) 评价超重及肥胖,并计算肥胖的检出率及发病率,采用χ²检验和log-binomial模型分析儿童期超重对青少年肥胖的影响。结果 小学一年级学生肥胖的检出率为4.89%,小学四年级时达到最高为6.99%,高中一年级时为4.43%。肥胖的发病率在小学二年级时最高为1.83%,高中一年级时降低到0.74%。小学一年级时超重的学生在高中一年级时肥胖累积发病率是小学一年级时正常体重学生的8.85倍(9年的累积发病率41.33% vs.4.67%,RR=8.85,95%CI:6.12~12.78)。结论 从小学一年级到高中一年级期间,儿童期肥胖发病率较高。儿童期超重明显增加青少年肥胖的风险。肥胖干预应该从儿童期开展,尤其应该重点关注超重的儿童。     

中国东中西部地区乙型病毒性肝炎流行现状

目的了解中国东、中、西部地区乙型病毒性肝炎(乙肝)流行现状。方法利用2002年中国居民营养与健康状况调查保留的血清开展乙肝病毒感染血清学检测。结果①中国东、中、西部地区全人群乙肝病毒表面抗原(HBsAg)标化阳性率分别9.20%、7.24%、8.24%。东部地区城市、农村全人群HBsAg阳性率分别为4.29%、11.79%;中部地区城市、农村全人群HBsAg阳性率分别为4.41%、7.84%;西部地区城市、农村全人群HBsAg阳性率分别为4.53%、9.05%。②东、中、西部地区<15岁儿童HBsAg阳性率分别为6.46%、4.47%、5.48%。东部地区城市、农村<15岁儿童HBsAg阳性率分别为2.29%、12.39%;中部地区城市、农村<15岁儿童HBsAg阳性率分别为1.61%、6.82%;西部地区城市、农村<15岁儿童HBsAg阳性率分别为2.57%、7.35%。结论中国东、中、西部地区全人群HBsAg阳性率均有不同程度下降,<15岁儿童下降最明显。表明中国自1992年将乙肝疫苗纳入儿童计划免疫管理效果显著。     

金属矿工与煤工尸检肺内粉尘及金属元素含量分析

目的 研究金属矿工与煤工尘肺尸检肺内偻尘、游主二氧化硅及元素的含量。方法 ３６例矿工尸检双肺样品,分别用Ｇｕｅｒｔ法、式外分光扫描法、原子吸收人姚光度法测定肺内粉尘、游离二氧化硅及金属元素含量。结果 随肺内滞留汾尘、游离二氧化硅含量的增加,尘病变加重;相同期别的金属矿工与采煤工尘肺,肺内粉法坦前者低于后者,游离二氧化硅量二者基本接近,肺组织中元素含量金属矿工高于采煤工,并与肺期别无关。结论 肺内粉     

西安市主城区健康乳母产后不同时期乳汁成分分析

目的研究人乳成分在不同时期的动态变化规律,以指导婴儿合理喂养。方法选取121名健康乳母,分别在其产后1~6、8、10、12月采集前乳和后乳,采用MIRIS HMA型人乳分析仪检测其中的蛋白质、脂肪、糖类、干物质含量以及能量。结果前乳和后乳中蛋白质含量在产后前3个月明显高于其它月份。乳汁中脂肪和能量的变化是一致的,前乳中脂肪、能量在产后12月内无差异,后乳中脂肪及能量10、12月组高于其它各组。产后1月前、后乳蛋白质含量差异无统计学意义,之后各组前乳均高于后乳。各个时期脂肪含量、能量、干物质后乳均明显高于前乳,而糖类含量前乳均高于后乳。结论人乳在产后不同时期有其自身的变化规律。     

High use of sedatives and hypnotics in ethnic minorities in Sweden

Objective. To study use of analgesics, and psychotropic drugs in relation to health indicators in four ethnic minorities in Sweden in comparison with Swedish-born. Design. Cross-sectional study based on data from the Survey of Living Conditions and Immigrant Survey of Living Conditions in Sweden in 1996. Study population. Random samples of 1890 Swedish residents, in the age range 27-60 years, born in Chile, Poland, Turkey and Iran and 2452 age-matched Swedish-born residents. Results. A two fold higher use of prescribed analgesics and antidepressants and a five to sixfold higher use of hypnotic and sedative drugs was demonstrated in members of ethnic minorities in Sweden in comparison with Swedish-born. In a multivariate analysis the higher use of prescribed analgesics and antidepressants was explained almost entirely by a higher morbidity in the minority study groups. A twofold higher use of sedatives and hypnotics was demonstrated in the minority study populations compared to the Swedish-born sample even after adjustment for extensive indicators of psychiatric and physical health in the multivariate analysis. Conclusions. The higher use of sedatives and hypnotics in relation to health in the minority samples in the present study indicates a differential treatment of minor psychiatric disorders of members of ethnic minorities in Swedish health services. Further studies that yield more qualitative data regarding the interaction of Swedish physicians with migrant patients are needed to explain these differences and to create a basis for intervention.     

上海市基层社区家庭病床服务与利用情况调研

目的全面了解上海市基层社区家庭病床服务与利用现状,为未来发展提供参考。方法对2017年上海市16个区241家基层社区家庭病床服务与利用现状进行问卷调查。结果2017年上海市基层社区家庭病床建床率为4.85‰,平均每家社区有225位家床患者,平均每家社区配备药物481.05种,平均每家社区推广16.11个家庭病床服务项目。结论上海市家庭病床服务推广应用率较高,各区家庭病床建床率基本达到上海市《家庭病床服务规范》要求。其中,中心城区社区在家庭病床建床率、家床患者数量、药品配备数量、服务项目开展等方面均优于郊区,上海市家庭病床服务仍有进一步提升空间。     

Gamma-hydroxybutyric acid Efficacy, potential abuse, and dependence in the treatment of alcohol addiction

The main objective in alcoholism therapy is to achieve and maintain abstinence and to prevent relapse. Pharmacotherapy may be necessary in treating persons who are not helped by group or psychosocial support alone. Among the substances experimented with in the past few years, gamma-hydroxybutyric acid has been effective in preventing alcohol withdrawal syndrome and in inducing a reduction in craving and an increase in the abstinence rate in treated alcoholics, in view of the alcohol-mimicking effects of the drug on the central nervous system. However, a possible development of craving for the drug and the risk of abuse and physical dependence have been reported in subjects who used gamma-hydroxybutyric acid for different reasons, including alcoholism therapy. The present review updates the existing differences in drug abuse behavior, side effects, and poisoning in the use of gamma-hydroxybutyric acid in a treatment alcoholism program and in self nonclinical illicit use.     

Techo de cristal y desigualdades de género en la carrera profesional de las mujeres académicas e investigadoras en ciencias biomédicas

ObjectiveTo identify in the international scientific literature the obstacles and potential promoters for the advancement of women academics and researchers in biomedical sciences during their professional careers.MethodPubMed, Scopus, CinahlPlus, Cochrane Database of Systematic Reviews, PsycInfo and Sociological Abstracts were systematically searched for articles published in English and Spanish between January 2006 and December 2016 on the phenomenon of the glass ceiling in women academics and researchers in biomedical sciences. The screening was carried out by independent reviewers.ResultsA total of 2254 studies were found, of which 23 were included in the review. The obstacles identified for the promotion of women academics and/or researchers in biomedical sciences are: gender bias in the evaluation of research results, individualism and lack of collaboration, women's lack of influence, the existence of gender inequalities in access to employment. The perception of sexism and discrimination in the work environment, and the difficulties in reconciling work and family life. The promoting elements are: examples of women in leadership positions, mentoring, facilitating conciliation, transparency in recruitment, participation in decision-making, gender assessment of research, awareness of gender inequalities in institutions, promoting collaboration, and pay equity.ConclusionsBy enhancing the elements favouring the promotion of academic women in biomedical sciences would help to reduce the glass ceiling in the career paths of women academics and health science researchers by increasing their participation, leadership and representation. A change of organizational and institutional values is required to achieve this.     

沈飞地区职工急性冠心病事件的流行病学研究

目的了解沈飞地区2574岁人群1992-2003年急性冠心病事件发病率的分布特点及变化趋势，及可能的影响因素。方法依照北京MONICA研究中心的研究方案，1992-2003年在沈飞地区对2574岁近3万人群开展了心血管病危险因素及发病、死亡的监测工作。以沈飞地区资料为依据，按年度、性别、年龄分别计算急性冠心病事件发病率的变化趋势。结果1992-2003年沈飞地区急性冠心病事件发病率呈轻度上升变化，有统计学意义。男性合计发病率为128．5／10万，大于女性51．4／10万：其差别有统计学意义（P〈0．01）。研究初期与研究末期相比，男性6574岁组每10万人群发病率的绝对增加幅度最大，差率为307．8／10万，男性5564岁组发病率相对增加幅度最大，差率为211％，均有统计学意义。医疗救助率为73．6％，高于北京市平均水平。发病集中在冬、春季，占总发病人数的58％。结论中关村地区中老年男性急性冠心病事件发病率呈显上升，应加强这一人群冠心病防治工作。     

Steroid profiles in urine and plasma of alcoholics during withdrawal

Metabolic profiles of steroids in urine and plasma were analyzed in 14 male and four female alcoholics during withdrawal. The daily excretion of 30 conjugated steroids in urine and the concentration of 13 steroid sulfates in plasma were measured on days 1, 7 and 29 of the period of observation, which started on day 5-7 of abstinence. While the total excretion of cortisol metabolites was normal in most cases, the profiles of metabolites were changed in the alcoholics during the period of observation. The ratio between tetrahydrocortisol and tetrahydrocortisone exceeded the mean normal value by more than one standard deviation in 97% of the samples analyzed. The same was true of the ratio between 20-hydroxy and 20-oxosteroids in 90% of the samples. The differences between alcoholic and healthy subjects were statistically significant (p less than 0.001). The major change in plasma was a significantly increased concentration of 5-androstene-3 beta, 17 beta-diol disulfate on the first day of the study. The concentration decreased to normal values during the first month of withdrawal. The rate of excretion of this steroid in urine was increased in half of the patients and also decreased with time. The rate of excretion and the degree of fatty infiltration in liver biopsies were positively correlated. It is suggested that the ratios between cortisol metabolites in urine might be of value as biochemical markers in alcoholism, and that the absolute or relative concentrations of steroid disulfates in plasma might serve as an indicator of recent alcohol intake.