绥化市医疗单位推行承包经营责任制效益分析

绥化市卫生局于1987年下半年开始,在全市城乡30个医疗单位(市级5个,乡镇级25个)全面推行了承包经营责任制。一、具体做法 1.承包形式 30个医疗单位中个人承包8个,集体承包16个,全员承包6个。单位内部临床科室实行个人任务承包的单位确17个,实行科室核算的有8个,两种形式都有的有5个。后勤工作有4个单位实行以质定价、以工计酬;21个单位实行岗位责任制,以分计酬;两种形式都有的有5个。 2.承包内容     

德阳卫生局“十一五”成就

覆盖全市城乡的医疗卫生服务网络基本建立。截止2010年底,全市共有医疗卫生机构2732个,其中:医院65个,卫生院148个,妇幼保健院6个,疾病预防控制中心7个,社区卫生服务机构58个,村卫生站1588个。灾后规划重建乡镇以上医疗卫生机构183个,总投资24.2948亿元,已全部开工,     

乳腺肿块良恶性诊断中使用超声弹性成像的临床研究

目的探讨乳腺肿块良恶性诊断中使用超声弹性成像的临床研究。方法选取我院接受乳腺肿块切除的住院病人,收集时间为2008年2月—2014年8月,共计350例,平均年龄（36.2±23.3）岁,中位年龄44.5岁,乳腺病灶共350个,患者在接受乳腺肿块切除前均行二维B超及超声弹性检查,350个病个均经手术后病理切片证实,其中良性病个170个,恶性病个180个,分别定义为良性组,恶性组。对所有乳腺病灶进行弹性成像打分,并且与最终的病理诊断进行对比。结果良性组170个结节,其中63个乳腺病,57个纤维腺瘤,17个乳腺炎,13个导管内乳头状瘤,6个纤维脂肪瘤,5个硬化性腺病、5个血管脂肪瘤,4个黏液腺瘤。恶性组中：160个浸润性导管癌,6个浸润性小叶癌,5个叶状囊肉瘤,3个湿疹样癌,黏液腺癌2个,1个乳头样癌,1个原位癌,1个髓样癌,1个高度糖原透明癌。170例良性结节平均得分为（1.76±0.65）分,180例;恶性结节平均得分为（4.3±1.21）分,良性结节平均得分与恶性结节平均得分差异有统计学意义（P〈0.05）。恶性组诊断准确率为96.7%,良性组诊断准确率为96.2%,恶性组诊断准确率与良性组诊断准确率作为差异无统计学意义（P〉0.05）。结论超声弹性成像能准确的区分良恶性乳腺肿块,对临床诊断乳腺肿块性质提供了新的无创手段。     

乳腺肿块良恶性诊断中使用超声弹性成像的临床研究

目的探讨乳腺肿块良恶性诊断中使用超声弹性成像的临床研究。方法选取我院接受乳腺肿块切除的住院病人,收集时间为2008年2月至2014年8月,共计350例,平均年龄（36.2±23.3）岁,中位年龄44.5岁,乳腺病灶共350个,患者在接受乳腺肿块切除前均行二维B超及超声弹性检查,350个病个均经手术后病理切片证实,其中良性病个170个,恶性病个180个,分别定义为良性组,恶性组。对所有乳腺病灶进行弹性成像打分,并且与最终的病理诊断进行对比。结果良性组170个结节,其中63个乳腺病,57个纤维腺瘤,17个乳腺炎,13个导管内乳头状瘤,6个纤维脂肪瘤,5个硬化性腺病、5个血管脂肪瘤,4个黏液腺瘤。恶性组中：160个浸润性导管癌,6个浸润性小叶癌,5个叶状囊肉瘤,3个湿疹样癌,黏液腺癌2个,1个乳头样癌,1个原位癌,1个髓样癌,1个高度糖原透明癌。170例良性结节平均得分为1.76±0.65,180例;恶性结节平均得分为4.3±1.21,良性结节平均得分与恶性结节平均得分差异有统计学意义（P〈0.05）。恶性组诊断准确率为96.7%,良性组诊断准确率为96.2%,恶性组诊断准确率与良性组诊断准确率作为差异无统计学意义（P〉0.05）。结论超声弹性成像能准确的区分良恶性乳腺肿块,对临床诊断乳腺肿块性质提供了新的无创手段。     

青岛市城乡卫生一体化现状与发展对策

1青岛市城乡卫生事业发展现状 截至目前,全市有各类卫生事业机构2 017个。其中,医院148个,卫生院108个,妇幼保健机构13个,专科疾病防治机构6个,疾病预防控制机构21个,卫生监督机构13个,诊所、卫生所、医务室1 570个,社区卫生服务机构259个。     

智力题

正1.中秋节之夜,小明全家欢聚。饭桌上有一个祖父、一个祖母,两个父亲,两个母亲,四个子女,三个孙子女,两个姐妹.两个儿子.两个女儿,一个公公.一个婆婆,一个媳妇。说了这么多.其实只有7个人。请问:七个人当中男、女各几人?小明如何称呼其余六人?2.四个好朋友去野炊,他们一个在挑水,一个在烧水,一个在洗菜,一个在淘米。现知道:甲不挑水也不淘米;乙不洗菜也不挑水;如果甲不洗菜,那么丁就不挑水;丙既不挑水也不淘米。     

走近改革试点“排头兵”——黑龙江省七台河市：为公立医院改革趟路

【七台河市】位于黑龙江省东部,是一座以煤炭工业为主、多业并举的新兴工业城市,全市辖三区一县,总人口90．22万。该市共有医疗卫生机构658个,其中医疗机构272个,公共卫生服务机构16个,村卫生所（室）370个。在医疗机构中,三级医院2个、二级医院3个、一级医疗机构25个,乡镇卫生院17个、社区卫生服务中心34个。     

研制我国疾病预防控制绩效考核指标体系

围绕层次化和条理化的考核框架,课题组经过＂指标收集—指标筛选—指标界定＂3个步骤,确立了我国疾病预防控制绩效考核指标体系：区域绩效考核6个类别17个指标,省级机构8个类别34个项目77个指标,市级机构8个类别35个项目110个指标、县级机构8个类别35个项目101个指标。一系列的研制思路、过程和方法确保了指标体系的科学性、合理性和可操作性,为后续确定指标权重、建立综合评价模型奠定了基础。     

聊城市2002年职业卫生监督检查情况分析

《职业病防治法》于 2 0 0 2年 5月 1日起实施。为深入贯彻落实《职业病防治法》及《有毒物品作业场所劳动保护条例》 ,全面掌握我市职业卫生现状 ,结合我市实际情况 ,2 0 0 2年 6月 ,对全市市直企业和部分县直不同行业企业进行了职业卫生监督检查。现将检查的情况进行分析。1　基本情况共检查聊城市和所辖 8个县 (市区 )企业 4 0个。市直企业 2 4个 ,县市区企业 16个。1.1　企业性质国有 14个、三资 4个、民营 5个、股份制 14个、乡镇 3个。1.2　行业分布机械加工制造 15个、电力 3个、化工 9个、纺织印染 5个、建材 2个、电子 2个、轻工 3…     

螺旋CT对原发性肝癌的诊断价值

目的探讨螺旋CT对原发性肝癌的诊断价值。方法回顾性分析58例经临床及病理证实的原发性肝癌患者的螺旋CT双期扫描表现。结果58例共发现病灶89个。其中肝左叶35个,肝右叶64个。肿瘤大小0.5～17.9cm,平均4.2cm。平扫发现病灶53个,27个表现为低密度,密度均匀者19个,7个不均匀密度病灶中可见到更低密度的坏死区或脂肪变性。肝动脉期扫描发现病灶82个,高密度均匀性强化75个,不均匀性强化6个,有1个无明显强化仍为低密度。门静脉期扫描发现病灶73个,均转化为稍高密度或等低密度影。结论螺旋CT能充分反映肝癌的血供特点,可为原发性肝癌的诊断提供更多可靠的信息及病变特征。     

The health service needs of small rural communities

ABSTRACT: In recent years econometric models used in health service planning have tended to encourage the downgrading or closure of small rural hospitals with the effect of reducing access to services and transferring costs from health authorities to consumers. These changes have occurred despite mounting evidence that people in rural communities have specific health service needs which require special attention. This study aimed to identify the perceptions of community members, health professionals and administrators regarding the health service needs in their small rural communities as a basis for developing a more comprehensive model of rural health service planning. Focus groups were held in three selected towns in Gippsland, exploring participants' perceptions of the meaning of health, health service needs, impact of health services, and the best set-up for health services. Consistent with previous research, key findings include: a broad conceptualisation of health; the perceived overwhelming importance of doctors, hospitals and chemists; the economic and social importance of a rural hospital; and a preference for all health services being provided under the one roof, funding and program flexibility, and local involvement in health service planning and implementation.     

Working across boundaries to improve health outcomes: a case study of a housing support and outreach service for homeless people living with HIV

This paper reports the findings of an evaluation of the 'Housing Support, Outreach and Referral' service developed to support people living with HIV who were homeless or at risk of homelessness. The service was set up as part of the Supporting People Health Pilot programme established to demonstrate the policy links between housing support services and health and social care services by encouraging the development of integrated services. The paper considers the role of housing support in improving people's health, and considers the challenges of working across housing, health and social care boundaries. The evaluation of the health pilot employed two main sources of data collection: quarterly project evaluation reports, which collected process data as well as reporting progress against aims and objectives, and semi-structured interviews with professionals from all key stakeholder groups and agencies, and with people who used services. Over the course of 15 months, 56 referrals were received of which 27 were accepted. Fifteen people received tenancy support of whom 12 were helped to access temporary accommodation. At the end of the 15 months, all of the tenancies had been maintained. In addition, 18 people registered with a general practitioner and 13 registered with an HIV clinic. Interviews with professionals emphasised the importance of the local joint working context, the involvement of the voluntary sector and the role of the support workers as factors that accounted for these outcomes. Those using services placed most emphasis on the flexibility of the support worker role. Importantly, interviews with professionals and those using services suggest that the role of support worker incorporates two dimensions – those of networker/navigator as well as advocate – and that both dimensions are important in determining the effectiveness of the service.     

The use of primary, secondary, community and social care by families who frequently consult their general practitioner

There have been very few studies that have examined either the use of other health and social services by patients who frequently consult their general practitioner, or the patterns of service use of frequently attending families. This study has three aims: to quantify the number of contacts to primary, secondary, community and social services of families who frequently attend their general practitioner; to examine the temporal patterns of these contacts and the patterns of use within families; and to determine the nature of these contacts and how they were valued by patients and health professionals. Thirty-five individuals in seven families completed diaries of health service use for 8 weeks; records from primary and community care records were analysed; health professionals and patients provided satisfaction scores for their contacts. The data were compared to standard datasets. The subjects made far more consultations with all health services than predicted, and less than half of these were with the general practitioner. Thirty-two per cent of the contacts with staff based within the health centre were not reported on the diary sheets. Temporal patterns of consulting were apparent within the families. The "index frequent attenders" within each family had most contacts. The differences between professional groups for the nature of the contact were marked, with over two-thirds of general practitioner contacts being for "specific symptoms or problems", and over two-thirds of health visitor contacts being for "weight problems". These findings show that patients who make high use of general practitioners' services also have a large number of contacts for health reasons with a range of other health and social services. These need to be considered as an outcome measure for trials of intervention for frequent attendance. More work is needed to explore why some individuals and their families make high use of health services.     

辽宁省医院改革与发展情况的考察报告

论述了江苏省卫生厅处级干部培训班对辽宁省医疗卫生改革与发展状况的考察所见和体会,从经营理念,办院方针,医院改革,人才培养和科技开发等方面介绍了辽宁７所医院改革举措,并就江苏省深化医疗机构的内部改革提出了建议。     

Dr John has gone: assessing health professionals' contribution to remote rural community sustainability in the UK

Due mainly to increasing difficulties in recruiting and retaining health professionals to work in remote and peripheral areas of Scotland, there is discussion of the need to implement new models of primary health care provision. However, innovative service models may imply a reduction in the number of health professionals who live and work in remote communities. Currently decisions about remodelling service provision are being taken by National Health Service stakeholders, apparently with little consideration of the wider social and economic impacts of change. This paper aims to argue that health professionals contribute to the fabric of rural life in a number of ways and that decisions about health service redesign need to take this into account. As well as fulfilling a wide health and social care role for patients, the authors seek to show that health professionals are important to the social sustainability of rural communities as, due to their unique position, they are often at the heart of networks within and between communities. The wider economic contribution of health services in remote communities is important, but often underplayed. The authors propose that theories of capital, principally the concept of social capital, could help in investigating the wider contribution of health professionals to their local communities. Ultimately, it is proposed that health services, as embodied in nurses, doctors and others, could be highly important to the ongoing livelihood and social infrastructure of fragile remote communities. Since this area is poorly understood, there is a need for prospective primary research and evaluation of service redesign initiatives.     

A WALK-IN AND TELEPHONE INQUIRY SERVICE

This article describes a study undertaken to evaluate the Walk-In and Telephone Inquiry Service provided by a social work department in a general hospital division of a large, voluntary, metropolitan teaching hospital. The major social work function provided in such a service is information and referral; to provide this service, a psychosocial evaluation and counseling are essential. This service is valuable to and utilized by many individuals, professionals and community agencies. It can become the point where individuals enter the health care system. Issues related to policy making, institional costs and cost benefits are discussed.     

Health and social care costs for young adults with epilepsy in the UK

Maintaining contact with services will help improve clinical and social outcomes as children with epilepsy move into their adult lives. This study has collated evidence on the extent to which young adults with epilepsy are supported by health and social care services posttransition, and the costs of such support. UK prevalence and service use data were taken from policy and research literature, as well as national data sets and reports. Costs were attached to these data to arrive at agency and overall total costs. There are approximately 42 000 young adults (18–25 years) with epilepsy costing the UK health and social care budgets £715.3 million per annum, on average £17 000 per young adult with epilepsy. A further £61 million falls to the social security budget. Most young adults with epilepsy will rarely use these services, but those with additional health needs have high and often long‐term support needs, including supported accommodation and personal care. Current resources used by these young adults are summarised but deficits in service availability can mean long waiting times and sub‐optimal treatment. Young adults also want more support to help them take advantage of education and employment opportunities and more information about managing the impacts of epilepsy on their lives. Improving services will cost money, but has the potential to lead to better outcomes for young adults.     

Privatization of health and publicization of violence: violence toward doctors in Turkey

In recent years, health professionals have been suffering from widespread violence in Turkey as well as in the world. Based on the data obtained from a fieldwork in Gaziantep and Kilis, this article aims to discuss neo-liberal transformation of the health sector and the consequences of this transformation in effecting violence toward doctors. The data shows that physicians working at public health institutions are the main victims of verbal and physical attacks coming from mostly patients and their companions. The social and economic context within which the violence toward physicians takes place is a process of restructuring of the provision of health service based on neo-liberal market logic. The health services and field are increasingly being shaped and redefined in accordance with economic logic like efficiency, profit, cost, competitiveness, and so on. These policy changes in the health sector have resulted in differentiation of health services, devaluation of public services, the stigmatization of employment in and consumption of, public health services as signs of low status as well as devaluation of general practitioners’ practices.     

加快人事制度改革增强卫生事业发展活力

介绍了南京市卫生系统人事制度改革的举措：（１）建立卫生人才中心,实现“单位人”向“社会人”的转变;（２）严格引进人才标准,发挥人才最佳配置效益。（３）实现干部能上能下,打破传统的铁交椅。     

从《执业医师法》与医学模式的转变谈医疗安全管理

要加强医疗安全管理，首先必须随着生物医学模式向生物－心理－社会医学模式的转化，不断拓宽我们的管理思维，要从生物，心理，社会这三个密切相关的致病环节中全闰地制订医疗安全措施，提高医护质量。同时还要以规章制度，法律法规，特别是《执业医师法》来约束医护人员的医疗行为，最大限度地减少医疗纠纷的发生。