党委在创建基本现代化医院中的保障作用

南通大学附属医院按照江苏省卫生厅"十五"期间医院工作的总体要求,从2001年起开始创建基本现代化医院的工作.他们认为,创建基本现代化医院是新时期医院建设与发展的有效抓手,而医院党委在创建基本现代化医院中的保障作用是至关重要的.持之以恒的党风廉政建设、医院文化建设和行风建设,使医院"以人为本"的理念深入人心,医院的内涵重量和社会形象也随之逐步提升.     

抓行风建设塑文明形象

依法执业诚信服务、创建文明卫生行业,是医院思想政治工作的重要组成部分。近年来,我院坚持以邓小平理论和“三个代表”重要思想为指导,以综合目标管理责任制、“白求恩杯”竞赛、创建基本现代化医院为栽体,全面贯彻落实“十六大”精神,三个文明齐抓共管,依法执业诚信服务,创建文明卫生行业．不断提升医院良好社会公众形象。     

以评促建努力提升医院管理水平

医院等级评审可以推动医疗机构加强内涵建设。经多方论证,江苏省建湖县第二人民医院于2010年启动创建二级中西医结合医院工作,遵循中西结合、中西医并重,围绕建设基本现代化中西结合医院的宏伟目标,主要从紧扣区域规划、抓好队伍建设、更新员工理念和提升医院发展内涵等4个方面着手做好创建工作,实现医院管理的持续改进。通过创建,医院员工的精神面貌、工作激情发生显著的变化,医院的医疗质量、患者的安全得到更好的保证,医院管理等方面收到的明显效果。     

坚持“以病人为中心”做好“创百佳”医院工作

一、工作思路 基本情况 自全国开展创建百佳医院以来,吉林省卫生行政部门对本省医院积极加以引导,充分调动其积极因素,激发各医院“以病人为中     

加强职业道德建设推进医院基本现代化进程

2002年，省卫生厅将我院列为首批创建基本现代化医院试点单位。作为具有基本现代化水平的医院，优美的环境、精湛的技术、先进的设备固然重要，但同时也需要有良好的职业道德。为此，4年多来，我们一直积极探索医院职业道德建设的新路子，以此推进医院基本现代化进程。     

创建基本现代化医院的实践与探索

基本现代化医院的提出体现了时代的要求,是卫生事业与经济社会协调发展的必然要求,是为"两个率先"服务的必然选择,是促进医院发展的有力抓手.基本现代化医院的内涵体现了时代的先进性,现代化的核心是先进性,把先进性的要求规范化,把规范的内容标准化、指标化.基本现代化医院的创建促进了医院的全面的进步.     

探索建设人文医院 促进医院科学发展——鼓楼医院建设人文医院回顾及展望

人文医院是指医院在经营管理规范、综合实力增强的基础上,通过人文精神的弘扬,营造医院内部以人为本的人文环境,在对员工实施人文管理的同时激发员工的人文道德关爱,运用体现人文关怀的服务手段去解除病人痛苦的一种医院发展模式。本文从人文医院建设的必要性、可行性和紧迫性三方面阐述了南京大学医学院附属鼓楼医院建设人文医院的背景,总结了该院2005年以来在加强医院文化建设、深化人文管理及提高人文服务水平等方面的主要做法,包括明确医院愿景,激情创建;营造服务氛围,全员创建;借助行业活动,扎实创建;善于兼收并蓄,智慧创建和坚持员工为本,全面创建。指出医院领导及中层干部的认识和榜样作用是人文医院建设的关键,人文医院的建设是一个长期过程,需要循序渐进,持之以恒,同时还要抓住机遇,顺势而为。     

突出"以人为本"创建基本现代化医院

南京医科大学第一附属医院,在落实江苏省卫生厅提出的建设基本现代化医院工作中,以科学发展观指导创建基本现代化医院,突出"以人为本",努力探索人性化服务的新模式.对外以病人为中心,努力从人性化角度开展服务,围绕"服务、技术、环境"三满意开展工作不断提高病人的满意度;对内以员工为本,为其工作和发展创造良好条件,帮助其实现人生价值,以调动工作积极性.     

应用主成分分析法评价医院控烟强度对无烟医院创建效果的影响

目的应用主成分分析法探讨医院控烟强度与无烟医院创建效果的关联,发现影响无烟环境创建的主要因素。方法采用分层随机抽样的方法,在7个省/直辖市中抽取210家医院,对医院控烟强度指标和无烟环境创建效果指标进行主成分分析和基于主成分的回归分析。结果控烟强度指标提取了2个主成分,分别反映了医院的禁烟制度及开展的工作、医院领导的控烟意愿及对患者开展的控烟工作,回归分析显示控烟强度的第一主成分对于无烟环境创建主成分得分变量有统计学意义(P<0.001)。结论医疗机构禁烟政策、无烟环境创建、烟草危害宣传及戒烟等方面的工作是影响无烟医院创建效果的主要因素,可用于评价无烟医院创建效果。主成分分析法可以简化无烟环境评价指标数量,发现影响创建效果的主要因素,具有较强的全面性和客观性。     

基于私有云医院一站式文件流转与存储平台的建立

为解决医院传统手工文件流转中易丢失、效率低下、投入成本高等问题,基于私有云优势,从支撑体系、系统基本构架、流程图简要分析一站式文件流转与存储平台的创建模式,并阐述该平台创建后可实现功能,发现其具有经济有效、易于操作、可安全管理的特点,是解决医院目前文件管理困境、适应动态变化的业务需求的有效途径.     

直肠癌三维适形和调强放疗物理计划的比较研究

目的:探讨三维适形和调强放疗对直肠癌放疗的物理计划特点。方法:选取5例直肠癌病例,进行CT扫描、靶区勾画和三维图像结构重建,分别在Cadplan治疗计划系统上进行三维适形和空间等分的3、5、7、9野的调强放疗计划设计,并对每一计划作出评价。结果:(1)三维适形放疗计划可满足计划靶体积(PTV)剂量要求,但重要器官的剂量分布较差。(2)4个调强放疗计划的PTV和重要器官剂量学参数均优于三维适形放疗计划,差异有统计学意义(P均<0.05),调强放疗计划间各项参数相互比较差异无统计学意义(P均>0.05)。结论:调强放疗在对直肠癌的放疗中较三维适形放疗有剂量分布的优越性。3野的调强放疗基本可以满足PTV和重要器官的剂量学要求,5野的调强放疗计划最优,7野和9野的调强放疗计划未能显示剂量学的优越性。     

The acceptability of personal learning plans in vocational training.

Personal learning plans have been advocated as a means of introducing the principles of adult learning into general practice vocational training. The aim of this study was to investigate attitudes amongst general practice trainers and registrars to the introduction and use of personal learning plans. A questionnaire was sent to general practice trainers and registrars in one vocational training scheme prior to the introduction of personal learning plans. Overall, doctors in the training scheme were positive to the idea of personal learning plans. Trainers were significantly more positive towards introducing learning plans than their registrars. Registrars in their final general practice posts were significantly more positive towards the idea of learning plans than their hospital counterparts. Doctors who had completed membership of the Royal College of General Practitioners, usually trainers or final year registrars, were also more positive in their attitude. This pilot study suggests that most trainers and registrars were positive in their attitude towards personal learning plans prior to their introduction in the Lincoln vocational training scheme. The study cautiously suggests a wider use and evaluation of personal learning plans in vocational training.     

“学案导学”模式在生理学教学中的应用

＂学案导学＂是以学案为操作材料,把教师的教学目标转化为学生的学习目标,把学习目标设计成一定的学习方案交给学生,以学生据案自学讨论、教师导学释疑为主要步骤,以教师调控为手段,注重学法指导,突出学生自学,重在培养学生学习能力和创新意识,从而提高学生综合素质的教学模式。将＂学案导学＂模式应用于生理学教学中,可以收到较好的教学效果。     

基于校园网的多媒体电子教案在生理教学中的应用探讨

随着医学教学改革的全面深化,形成以学生为主体的自主学习机制是非常重要的。将多媒体电子教案融入生理学教学,有利于培养学生自主学习能力,改革旧的教学模式。文章探讨了基于校园网的多媒体电子教案在生理学教学中的优势、具体设计及存在的问题,力求为生理学课程的教学提供一种有益尝试。     

Gaps, conflicts, and consensus in the ethics statements of professional associations, medical groups, and health plans

BACKGROUND: Patients today interact with physicians, physician groups, and health plans, each of which may follow distinct ethical guidelines. METHOD: We systematically compared physician codes of ethics with ethics policies at physician group practices and health plans, using the 1998-99 policies of 38 organisations-18 medical associations (associations), nine physician group practices (groups), and 12 health plans (plans)-selected using random and stratified purposive sampling. A clinician and a social scientist independently abstracted each document, using a 397-item health care ethics taxonomy; a reconciled abstraction form was used for analysis. This study focuses on ethics policies regarding professional obligation towards patients, resource allocation, and care for the vulnerable in society. RESULTS: A majority in all three groups mention "fiduciary obligations" of one sort or another, but associations generally address physician/patient relations but not health plan obligations, while plans rarely endorse physicians' obligations of advocacy, beneficence, and non-maleficence. Except for occasional mentions of cost effectiveness or efficiency, ethical considerations in resource allocation rarely arise in the ethics policies of all three organisational types. Very few associations, groups, or plans specifically endorse obligations to vulnerable populations. CONCLUSIONS: With some important exceptions, we found that the ethics policies of associations, groups, and plans are narrowly focused and often ignore important ethical concerns for society, such as resource allocation and care for vulnerable populations. More collaborative work is needed to build integrated sets of ethical standards that address the aims and responsibilities of the major stakeholders in health care delivery.     

巨块肝癌分靶区计划设计与评估

目的为了提高肿瘤的覆盖率,减小漏照体积,探讨对巨块肝癌分靶区治疗计划进行设计。方法选取巨块肝癌2例,首先把计划靶区(PTV)作为一个靶区进行计划设计;然后进行分靶区计划设计,把PTV分成3个子靶区,分别为PTV1、PTV2和PTV3。PTV1和PTV3为计划设计区,PTV2是PTV1与PTV3之间的间隔区。然后对这两种方法设计出来的结果进行对比和评估。结果分靶区与单靶区计划设计相比,两个病例的肿瘤覆盖率分别提高了15.94%和32.49%,靶区的漏照射体积减少135.78cc(78.20%)和227.37cc(97.02%)。结论分靶区计划设计的方案解决了巨块肝癌计划设计困难和边缘剂量不足的问题,大大提高了肿瘤的覆盖率。分靶区计划设计增加了患者的治疗次数,延长了治疗时间。     

食管癌术后纵隔淋巴结转移容积旋转调强与静态调强放疗的剂量学对比研究

目的比较容积旋转调强（volumetric modulated arc therapy,VMAT）与静态调强（intensity modulated radiotherapy,IMRT）放疗技术治疗食管癌术后纵隔转移淋巴结的剂量学差异。方法对25例胸段食管癌术后纵隔淋巴结转移患者分别设计逆时针VMAT计划和5野IMRT计划,在满足靶区处方剂量要求下,通过剂量体积直方图（DVH）评价和比较2种类型治疗计划的适形性指数（CI）,均匀性指数（HI）,脊髓最大剂量（Dmax）、V40（Vx为xGy剂量曲线包含相应器官体积百分数）,双肺V5、V10V20、V30胸腔胃V40、V50、平均剂量（Dmean）,心脏V40、V50、Dmean。并比较2种治疗计划总机器跳数（monitorunit,MU）和治疗时间。结果全组25例患者的VMAT计划和IMRT计划均能满足临床剂量学要求,在靶区覆盖率相似的前提下,VMAT计划靶区（PTV）CI优于IMRT计划,差异具有统计学意义（P〈0．05）,HI差异无统计学意义（P〉0．05）。与IMRT计划相比,VMAT计划中双肺V5、V10有所上升,V20、V30明显降低（P〈0．05）;脊髓Dmax显著降低（P〈0．05）;胸腔胃V40、V50明显减少（P〈0．05）;心脏V30V40、Dmean略有上升趋势,但差异无统计学意义（P〉0．05）。结论VMAT靶区适形度更高,降低周围重要正常组织高剂量范围,这可能减少正常组织放疗反应,同时可通过降低MU和缩短实际治疗时间,提高肿瘤治疗效果。     

射野准直器跟随功能在胸上段食管癌容积旋转调强计划中的应用

目的：探讨射野准直器跟随功能在胸上段食管癌容积旋转调强计划中的剂量学影响。方法选取11例胸上段食管癌放疗患者,在瓦里安Eclipse治疗计划系统上分别设计两种计划：RapidArc和JT‐RapidArc。比较靶区和危及器官的剂量体积参数、适形度指数（CI）、剂量均匀性指数（HI）、正常组织低剂量体积（B‐P）及机器跳数（MU）。结果与RapidArc计划比较, JT‐RapidArc计划降低了PTV1（64）、PTV2（54）的平均剂量和高剂量（D2）受照体积,提高了PTV1（64）的低剂量区域（D98）和 HI （P＜0．05）,但PTV1（64）的CI二者差异无统计学意义（P＞0．05）。JT‐RapidArc计划肺的（V5、V10、V13、V20、V30、Dmean ）、心脏的（V20、Dmean ）、B‐P的（V5、V10、V15、V20、V30）明显低于RapidArc计划（P＜0．05）,脊髓计划区和脊髓的差异二者间差异无统计学意义（P＞0．05）。JT‐RapidArc计划的MU（349±29）比RapidArc计划的MU（345±16）略微增加1％（P＞0．05）。结论两种计划均能满足临床治疗需求,JT‐RapidArc计划在提供了更优的部分靶区剂量分布情况下,能更好地有效保护肺、心脏和正常组织低剂量区域,MU仅略微增加。     

Quality of care in investor-owned vs not-for-profit HMOs.

CONTEXT: The proportion of health maintenance organization (HMO) members enrolled in investor-owned plans has increased sharply, yet little is known about the quality of these plans compared with not-for-profit HMOs. OBJECTIVE: To compare quality-of-care measures for investor-owned and not-for-profit HMOs. DESIGN, SETTING, AND PARTICIPANTS: Analysis of the Health Plan Employer Data and Information Set (HEDIS) Version 3.0 from the National Committee for Quality Assurance's Quality Compass 1997, which included 1996 quality-of-care data for 329 HMO plans (248 investor-owned and 81 not-for-profit), representing 56% of the total HMO enrollment in the United States. MAIN OUTCOME MEASURES: Rates for 14 HEDIS quality-of-care indicators. RESULTS: Compared with not-for-profit HMOs, investor-owned plans had lower rates for all 14 quality-of-care indicators. Among patients discharged from the hospital after myocardial infarction, 59.2% of members in investor-owned HMOs vs 70.6% in not-for-profit plans received a beta-blocker (P<.001); 35.1% of patients with diabetes mellitus in investor-owned plans vs 47.9% in not-for-profit plans had annual eye examinations (P<.001). Investor-owned plans had lower rates than not-for-profit plans of immunization (63.9% vs 72.3%; P<.001), mammography (69.4% vs 75.1%; P<.001), Papanicolaou tests (69.2% vs 77.1%; P<.001), and psychiatric hospitalization (70.5% vs 77.1%; P<.001). Quality scores were highest for staff- and group-model HMOs. In multivariate analyses, investor ownership was consistently associated with lower quality after controlling for model type, geographic region, and the method each HMO used to collect data. CONCLUSIONS: Investor-owned HMOs deliver lower quality of care than not-for-profit plans.     

Health USA. A national health program for the United States.

The Health USA Act of 1991 addresses two fundamental health services financing problems: the more than 30 million uninsured persons and the rising costs for health care and for health insurance. Health USA would provide coverage of the entire resident population for comprehensive medical and preventive health and long-term care services through a universal tax-funded financing system. The federal government would contribute an average of 87% of program costs to each state, which would establish, under federal guidelines, a state health program. Each individual or family may enroll in any health plan approved by the state program, including many private plans, or a plan run by the state program. Through the approved plan of their choice, enrollees would receive covered services and obtain their care from participating physicians and other professional practitioners, hospitals, and other facilities. The state program would pay approved plans a capitation payment for every person enrolled. The plans would pay professional providers fees, as part of an all-payer system of fee schedules and expenditure targets, or capitation payments or salary. Hospitals would be financed through global budgets negotiated by the state program with each hospital. The plan run by the state program would pay the health care costs of any person who does not enroll in an approved plan, making the state plan the payer of last resort and eliminating uncompensated care and cost shifting by providers. Health USA would separate health care coverage from employment, ensuring uninterrupted coverage and eliminating employers' administrative role in providing coverage. Federal and state taxes would replace present methods of financing by private insurance premiums and large out-of-pocket expenditures. Building on the present system of health plans, Health USA would offer all persons a wide choice of competing plans in which to enroll and offer professional providers a wide choice of plans in which to practice. It would control costs by increasing financial accountability of providers and health plans, reducing present reliance on intrusive utilization review and on patient cost sharing. By controlling health care and administrative costs, Health USA would cover the entire population and, according to independent cost estimates, reduce national health expenditures by $11.5 billion in 1991.