某院临床科主任质量管理认知调查

通过对某院39位临床科主任进行问卷调查发现,部分科主任对医疗质量管理的相关要求并未完全掌握,或是未落实到科室的工作实践中。建议应充分发挥科主任在医疗质量管理中的核心作用,通过加强培训和管理考核,提高科主任开展科室质量管理的认识和能力,不断提升医院医疗质量管理水平。     

绩效管理如何驱动公立医院管理能力跨越发展——基于DRGs的案例分析

目的:评估驱动型绩效管理实践对公立医院管理能力发展的效果。方法:通过参与式观察研究绩效管理实践规律。基于DRGs,采用双重差分回归,分析实践对医疗(服务)费用变化的影响。结果:(1)总结了驱动型绩效管理的"一条线,三阶段,一平台"整合实践模式;(2)发现案例组住院医疗费用增速控制效果明显;(3)发现案例组医疗服务费用提升更明显。结论:驱动型绩效管理整合实践促进公立医院管理能力跨越发展。     

浅谈药物不良事件报告系统的建立

JCI的基本理念之一是基于促进医疗质量与患者安全的持续性改进的原则,其中强调对影响患者安全的意外不良事件进行根本原因分析,使每个科室成员都能从不良事件中吸取经验,采取预防对策,使风险防御能力得以持续提升,以实现保证患者安全和提升医疗质量为核心的医院管理目标。本文通过探索建立不良事件报告系统,提高个人、科室防范不良事件的能力,提升医疗质量和安全。同时通过推广、扩展至科间、院际的交流,找到危害的根源,累积经验,分析趋势,实现经验分享与交流,更大范围实现患者安全的管理目标。     

Validity in assessing time processing ability, test equating of KaTid-Child and KaTid-Youth

Background There is a need for instruments with acceptable psychometric properties for measuring time management/time processing ability. KaTid‐Child (Swedish: Kit for assessing Time processing ability) was developed for children aged 5–10 years. To meet needs of assessing older children, KaTid‐Youth was created. The aim of this study was to investigate the validity of KaTid‐Youth. Methods This study investigates the validity of KaTid‐Youth using Rasch models: partial credit and common item equating. Results Results indicate that KaTid‐Youth has acceptable psychometric properties and seems to measure the same construct as KaTid‐Child. Conclusions Indications of gender differences in the sample call for further research. The results indicate that time processing ability can be seen as one construct in which time perception, orientation and management can be operationalized as different levels of complexity in time processing ability. Expressions of time processing ability differ at different ages. Thus, early intervention in time perception and time orientation may be needed to promote time management in later childhood. Professionals need to take time processing ability into consideration when meeting children who risk delayed development of daily time management.     

Escherichia coli O104:H4 outbreak from sprouted seeds

From May to July 2011, one of the largest reported outbreaks of haemolytic uraemic syndrome (HUS) and bloody diarrhoea caused by the Shiga toxin-producing Escherichia coli (STEC) O104:H4 occurred in Germany and France. The hypothetical origin of the outbreak strain was a combined enteroaggregative E. coli and an enterohaemorrhagic E. coli with the ability to resist multi-antibiotics and produce Shiga-toxin 2. The combination of aggregative ability, antibiotic resistance and the production of Shiga-toxin 2 significantly affected the severity of the symptoms presented. Since humans may be the primary reservoir, it is likely that contamination could have occurred through contact with infected individuals. Farm food safety management, and hand hygiene training programmes are crucial to primary production to prevent or reduce risks of contamination.     

Stress Management as a Component of Occupational Therapy in Acute Care Settings

The recent explosion of stress literature in the medical community has created a new awareness of "stress" as a potentially destructive force in itself. Contributing the physical and psychological dysfunction, stress has now been linked with a wide range of diagnoses including cancer, cardiac disease and arthritis. The importance of incorporating stress management activities into daily life is increasingly apparent. Occupational therapists concerned with patients' ability to achieve health enhancing independent living skills are in a key position to help patients master stress management skills and incorporate them into activities of daily living. This article will explore the incorporation of stress management into occupational therapy programming for a variety of acute care patients. It will review the components of stress, the stress cycle, the relaxation response, the occupational therapy role based on a model of human occupation, and will review current programs through case study of four patients: one diagnosed with cancer (leukemia), one with anorexia nervosa, one with chronic pain and the fourth, a patient in medical intensive care.     

Comparison of Health Buddy with traditional approaches to heart failure management

The purpose of this pilot study was to (a) determine the feasibility of providing a heart failure disease management program through an in-home telehealth communication device (Health Buddy) and (b) compare the effectiveness of the Health Buddy with traditional home management strategies (telephonic, home visit) in achieving selected patient outcomes (self-efficacy, functional status, depression, and health-related quality of life). Ninety participants completed the study through 2 months. Thirty percent of participants were either eliminated prior to or withdrawn after enrollment from the study based on Health Buddy issues. A mixed model ANOVA revealed those who received telephonic disease management experienced decreased confidence in their ability to manage their heart failure whereas all other groups experienced increased confidence. Further ANOVA analyses indicated improvement over time with no group differences for functional status, depression, or health-related quality of life. These findings suggest that delivering a disease management program through a telehealth communication device is feasible and may be as effective as traditional methods.     

医学院校化学实验室安全管理的探讨

目的：探讨实验室安全管理对医学化学实验室管理的重要性。方法：通过加强医学化学实验室日常安全管理和实验教学过程中安全管理措施,提高实验人员的安全意识,保证化学实验室财产及人员的安全。结果：建立一个有序、安全、舒适的实验室安全运行机制,以实现实验教学安全管理的目标。结论：实验室安全管理贯穿于实验教学与科研活动的各个环节,只有加强和规范化学实验室的安全管理,才能保证学校教学和科研工作正常有序的进行,使实验室成为培养学生动手能力、实践技能、创新意识和能力的重要基地。     

Quality management forces computerization decisions

It is unlikely the quality management program of the future will be able to effect quality improvements without sophisticated information management tools, one of which is the computer. While computerization is not required by the Joint Commission's Performance Assessment and Improvement Standard nor the Information Management Standard, both standards compel organizations to improve their information system capabilities. If the hospital quality management office attempts to survive without computerization, its ability to manipulate the many data elements required for measurement, assessment and improvement will be severely limited. Begin now to plan your computerization strategy.     

Maximising the benefits of competing non-core support services

Sarah Meads is General Manager of Serco Health Services. In an earlier article "Transforming Support Services Through Competition", published in the September/October 1992 issue, she described the use of external competition to create incentives to transform support service functions. In this article she describes how competing single service contracts or simply combining services that appear functionally related, for example, cleaning and orderly services, is no longer enough if health service providers are serious about maximising the benefits of competition. This is because a superior result may be achieved through combining several support services under one single contract, or facilities management contracting, selected on the basis of delivering client outcomes. The ability to maximise the benefits relies on providers adopting a change in attitude and a relentless focus on client needs which is not constrained by existing organisational structure.     

A comparison of knowledge, synthesis, and clinical judgment. Multiple-choice questions in the assessment of physician competence

This study compares the reliability, validity, and efficiency of three multiple-choice question (MCQs) ability scales with patient management problems (PMPs). Data are from the 1980, 1981, and 1982 American Board of Internal Medicine Certifying Examinations. The MCQ ability scales were constructed by classifying the one best answer and multiple-true/false questions in each examination as measuring predominantly clinical judgment, synthesis, or knowledge. Clinical judgment items require prioritizing or weighing management decisions; synthesis items require the integration of findings into a diagnostic decision; and knowledge items stress recall of factual information. Analyses indicate that the MCQ ability scales are more reliable and valid per unit of testing time than are PMPs and that clinical judgment and synthesis scales are slightly more correlated with PMPs than is the knowledge scale. Additionally, all MCQ ability scales seem to be measuring the same aspects of competence as PMPs.     

缩短≤34周早产儿完全经口喂养过渡时间

成功经口喂养是早产儿住院治疗后出院的重要标准之一。≤34 w早产儿完全经口喂养面临较多困难。成立品管圈组，通过流程分析、数据统计及原因解析,从统一经口喂养能力评价标准、制定经口喂养标准化干预方案、重视排便管理、重视母乳喂养等方面改进，使≤34 w早产儿完全经口喂养过渡时间从平均18.5 d缩短至8.8 d。品管圈活动开展，完善了≤34 w早产儿喂养管理模式，缩短了早产儿完全经口喂养过渡时间，对提高早产儿生存质量具有重要意义。     

Telemedicine: New technology = new questions = new exposures

Cyberspace, telemetry, and virtual reality all refer to mankind's evolving ability to be in two places at once, without ever leaving one location. Now this ability has expanded into the world of medicine, with increased awareness of risk management concerns, and questions about where we go from here.     

论“八商”修养对护士长管理素质的培养

护士长是护理管理的核心,提高护理管理能力又是做好管理工作的核心。本文分析"八商"修养模式在护理管理中的应用,明确"八商"修养对于护士长管理素质培养的重要意义,为护理管理质量的提高和护士长综合素质培养提供借鉴。     

医疗设备质量安全和维护管理

目的:通过医疗设备的质量安全和维护管理,提高医学工程部门对医疗设备的保障能力。方法:对医疗设备质量管理、质量控制以及预防性维护等进行具体分析。结果:建立完善的医疗设备质量安全控制机制及预防性维护(PM)措施,实现医疗设备的全程质量跟踪管理。结论:对建立科学的医疗设备质量控制体系,提升医学工程部门的专科地位有现实指导作用。     

Trust in older persons: A quantitative analysis of alignment in triads of older persons,informal carers and home care nurses

Self‐management by older persons could be influenced by the level of trust found in triads of informal carers, formal care providers and care recipient, the older person. Little research has been done on care providers’ trust in older persons. This study aims to explore the level of trust that informal carers and home care nurses have in older persons, the extent of alignment in triads and the relationship between trust in older persons and self‐management. We conducted a cross‐sectional survey study in the Netherlands, sampling 133 older persons, 64 informal carers and 72 nurses, which resulted in 39 triads. Alignment level was analysed through Intraclass Correlation Coefficient 1 scores and absolute and mean difference scores. Correlation analysis and one‐way analysis of variance measured the relationship between trust and self‐management. The results show that triads contain both alignment and misalignment. Misalignment occurs mostly when informal carers and nurses have little trust in the older person while this person views their own behaviour towards their caregivers positively. Care providers’ trust levels relate significantly to their perception of the person's ability to self‐manage, but not to the person's self‐rated ability. This could be explained by care providers not communicating their intrinsic trust in the older person to them. Trust building could be enhanced by organising discussions of mutual expectations of trust and both formal and informal care providers could benefit from compassionate assessment training, to learn how to openly express their trust in the older person.     

流程管理在医院中的应用

流程管理是企业内应用较为广泛的一个管理方法,在医院中也有一定的借鉴意义。特别是其对医院内部跨专业、跨部门的管理,很值得借鉴。通过流程管理实施及流程图设计,简要介绍流程管理的方法及内容。     

Immunologic Unresponsiveness

Two lymphoid cell populations, one from the bone marrow, the other from the thymus, are involved in the immune response to a specific antigen. If either is rendered unresponsive, the individual will be tolerant of that antigen. The significance of this concept for our understanding of autoimmune diseases, for enhancing the ability to transplant organs, and for the management of cancers is evaluated.     

宁夏同心县实施特困医疗救助的实践与思考

宁夏同心县是秦巴卫生项目县之一，该县医疗救助的实施已形成了一套较为完善、行之有效的监督管理办法及制度。其主要做法为：(1)强化组织领导，加强宣传力度；(2)严格把关，选准、选好救助对象；(3)严格监管，确保救助效果。特困医疗救助的实施，为老百姓就医减轻了负担，提高了卫生院的服务能力。为探讨农村实施合作医疗、贫困医疗救助提供了宝贵的经验。     

Self management or managerial autonomy. SESPAS report, 2012

Western countries with strong primary care systems organize their health services around this healthcare modality, which serves as a gateway to the system and is characterized by multidisciplinary teamwork, management transferred to the teams and a broad services portfolio. The contractual relationship between professionals and the public health system is a useful tool to modulate the efficiency of services and their ability to meet the expectations of citizens and professionals. Some countries choose to contract professionals directly, either individually or through a professional organization, an option known as a self-management system. Others opt to contract public or private entities, which in turn recruit health professionals as employees. In the latter countries, the concept of management decentralization and managerial autonomy has arisen. In Spain, only Catalonia has enabled professional entities to be hired to provide public health services, through commercial formulas, i.e. in a competitive market relationship. This relationship allows the use of corporate governance mechanisms that are not subject to public control through state intervention. The other forms of management promoted in Spain to avoid the controls of state intervention - foundations or associations - have been unsuccessful, except in the autonomous region of Valencia and some models in the autonomous region of Madrid.