综合性医院开展肝炎专科便民门诊的探讨

目的 总结肝炎专科便民门诊的优势,为便民门诊的开展和普及提供依据。 方法 在符合医院感染管理的要求下,从 2009 年起针对肝炎门诊患者的特点,以“一切以病人为中心”为服务理念,开展肝炎专科便民门诊,优化服务流程,缩短患者看病时间。 结果 肝炎专科便民门诊缩短了患者看病时间,提高了患者满意度。结论 通过开展肝炎专科便民门诊,分流疏导部分患者,解决更多患者“挂号难,看病难”问题,改善就诊流程,简化就诊手续,最终赢得患者认可,值得推广。     

一站式护理服务路径在乳腺专科中的实践初探

目的：配合我院乳腺疾病诊治中心一站式医疗工作的开展,探索一站式护理服务实施路径,进一步优化服务流程、提高就诊效率和患者满意率。方法：在一站式硬件基础上,制定各种临床护理路径,使病房、门诊、日间化疗等紧密有效运转,整合各项功能于一体,做到专科的“一站式护理服务”。结果：实施一站式服务后,2011年门诊量较2010年同期增长了61.20%;手术量增长了26.79%,患者对护士的满意度明显提高。结论：一站式护理服务在提高患者满意率、有效利用医疗资源、促进专科护理发展等方面均起到积极作用。     

医院"一站式"服务流程图及就诊导向图的编制与应用效果

目的探索服务流程图、就诊导向图在"一站式"服务模式护士站的应用效果.方法根据不同专科病人就诊过程,以"优化流程,简化环节;提供就诊咨询、导诊便民服务"为流程编制原则,按照就诊环节和护理过程并结合有形展示策略编制流程导向图.结果流程图能规范护士服务行为,提高服务满意度;导向图能个性化地为就诊病人提供清晰的诊疗导向,避免病人就诊过程的盲目性,减少就诊期间非诊疗的耗时;护理流程图在人员、技术、环境不变的情况下,能有效地从根本上改善服务质量和提高工作效率.结论护理工作流程图、就诊导向图在改进医疗服务工作中起到了"简化流程、提高效率、优化服务质量、方便病人就医"的作用.     

医院“一站式”服务流程图及就诊导向图的编制与应用效果

目的探索服务流程图、就诊导向图在“一站式”服务模式护士站的应用效果。方法根据不同专科病人就诊过程，以“优化流程，简化环节；提供就诊咨询、导诊便民服务”为流程编制原则，按照就诊环节和护理过程并结合有形展示策略编制流程导向图。结果流程图能规范护士服务行为，提高服务满意度；导向图能个性化地为就诊病人提供清晰的诊疗导向，避免病人就诊过程的盲目性，减少就诊期间非诊疗的耗时；护理流程图在人员、技术、环境不变的情况下，能有效地从根本上改善服务质量和提高工作效率。结论护理工作流程图、就诊导向图在改进医疗服务工作中起到了“简化流程、提高效率、优化服务质量、方便病人就医”的作用。     

优化服务流程在急诊抢救患者中的应用效果评价

目的:探讨优化服务流程在急诊抢救患者中的应用效果。方法:将优化服务流程前与优化服务流程后的患者各80例划分成对照组和实验组,对照组应用传统急诊服务流程,实验组通过加强院前、院内急救的一体化建设,建立预检分诊系统,开通绿色通道,缩小功能区的服务半径,专科前移,建立应急预案,成立应急小组等措施优化服务流程,比较两组的就诊等待时间、急诊诊疗时间、满意度、抢救成功率。结果:优化服务流程后急诊抢救患者就诊等待时间和急诊全程诊疗时间缩短,患者及家属满意度和抢救成功率提高。结论:优化服务流程可缩短急诊患者就诊等待时间及急诊诊疗时间,提高患者的满意度及抢救成功率。     

基于不同就诊环节的门诊病人满意度调查

[目的]门诊病人满意度,改进门诊服务质量.[方法]采用自行设计的调查问卷对1300例门诊病人进行调查,调查内容包括就诊环境、就诊流程、医疗服务及预约诊疗4个方面.[结果]对医院门诊总体满意度评分为（4.05±1.00）分,32.00%病人因专家停诊未能就诊,18.31%病人认为候诊时间长,10.85%病人对专家医疗技术不放心.[结论]医院应做好医疗资源配置规划,加强出诊医生管理,优化流程,缩短病人候诊时间,提高环节服务质量.     

门诊病人的就诊需求分析

目的:为了在门诊"一切以病人为中心"的服务理念中体现人性化护理服务,为病人提供优质护理。方法:通过自行设计的问卷调查门诊病人的需求。针对这些需求及门诊护理工作的特点,提出作为门诊护士长及护士的管理要求。结果:病人需求最高的是高操的医疗技术和早就诊,早明确诊断,尽早治疗的迫切心理,各占95.18%、94.68%;其次是希望能有一简便、快捷、明了的就诊流程占88.59%,再其次为希望得到医护人员关注,对医护人员态度的要求比例也较高各占调查的85.17%和83.36%。结论:通过了解病人的需求,从护理的角度有针对性的实行有序管理,改善就诊流程,简化就诊手续,最终赢得病人的认可,使病人满意度提高至95%以上。     

基于不同就诊环节的门诊病人满意度调查

[目的]门诊病人满意度,改进门诊服务质量。[方法]采用自行设计的调查问卷对1 300例门诊病人进行调查,调查内容包括就诊环境、就诊流程、医疗服务及预约诊疗4个方面。[结果]对医院门诊总体满意度评分为(4.05±1.00)分,32.00%病人因专家停诊未能就诊,18.31%病人认为候诊时间长,10.85%病人对专家医疗技术不放心。[结论]医院应做好医疗资源配置规划,加强出诊医生管理,优化流程,缩短病人候诊时间,提高环节服务质量。     

门诊预存诊疗服务新模式的实践与探讨

<正>近几年,卫生主管部门多次明确提出,医疗机构应以病人为中心,科学、合理设计医疗服务流程,采取有效措施创新、简化门急诊就诊程序[1]。各级医疗机构纷纷行动起来,以信息技术为支撑,不断优化服务流程。"预存式诊疗,一次性付费"是一项服务新举措,即病人在门急诊诊疗时,先预缴押金,不必在接受每项诊疗服务时单独缴费,待本次所有诊疗过程结束后再统一结算。这种新型服务模式实现了对门诊流程的重组,从根本上解决原始门诊流程的弊病,使病人真正成为受益者[2]。预存诊疗模式管理实践     

设立门诊服务中心的做法与体会

目的提高门诊医疗服务质量,实现“以病人为中心,满足病人需要为目标”的服务宗旨。方法通过设立门诊服务中心,建立“一站式服务台”,共设有院长代表、导诊导医、预约、审批、咨询、便民等6个服务席位,并采用问卷调查表评估服务措施实施的效果。结果门诊服务中心的设立得到了病人和医务人员的赞同和支持,门诊服务中心设立前后病人满意度有显著性差异(P<0.01)。结论门诊服务中心的设立是可行的、必要的,符合以人为本的原则,值得推广。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.