医院门诊服务管理的现状、问题与对策

门诊服务是综合性医院管理水平的重要标志。本文通过对我院2004～2006年的门诊业务统计资料进行分析,评价门诊服务的质量与绩效,探讨我院门诊服务管理中存在的问题及其原因,提出改善门诊服务管理的对策。     

我市三级医院门诊服务质量满意度的调查分析

门诊是医院对外服务的窗口，门诊服务质量的优劣将直接影响医院的信誉和效益，提高门诊满意度是改善医患关系，增强医院竞争力的有效手段。本文根据本市4家三级医院2005年就诊者对门诊服务质量满意度评价的调查结果，分析原因，发现问题，探讨有利于提高门诊服务质量的措施。为扩大医院就诊范围，满足患者需求，提高各医院的竞争力，提供参考依据。     

疫情常态化防控期间儿童医院门诊投诉原因分析及措施

目的：探讨疫情常态化防控期间某儿童医院门诊医疗投诉的具体情况,并在实践中不断完善相应的处理措施,提高儿童医院门诊服务质量。方法：梳理某儿童医院2020年和2021年受理的1 413例投诉,分析不同年份投诉数量、投诉原因的变化。结果：门诊投诉例数从2020年的578例上升至2021年的835例,门诊投诉率从2020年的2.78?上升至2021年的3.13?。门诊投诉原因中,医疗资源、医院管理和医疗质量所占比例由2020年的32.70%、13.84%和4.50%上升至2021年35.93%、28.38%和5.27%,医患沟通和医院制度所占比例同比下降6.05%、11.57%。结论：疫情常态化防控时期,医院更应高度重视门诊投诉,分析总结投诉原因,加强门诊管理,优化服务模式,提高医疗服务质量。     

门诊医疗服务过程质量问题的原因分析

为了解与分析上海社区门诊医疗服务过程质量中存在的问题的主要原因 ,以利于确定提高门诊医疗服务过程质量的对策 ,我们进行了门诊医疗服务过程质量问题的原因调查。一、调查内容和方法(一 )调查内容 :包括 :①门诊常见疾病医疗服务过程质量问题的原因 ;②同病种门诊常见疾病医疗服务费用差异的原因 ;③门诊其他医疗服务过程质量问题的原因。(二 )调查方法 :在上海市区随机选择 12所社区卫生服务中心及 6所二级医院 ,对所有内科门诊医生和医院临床医疗管理者共 2 0 3人 ,进行问卷调查。其中男性占 35 4 7% ;年龄≥ 4 0岁占 6 4 0 4 % ;学历…     

基于数字化平台的妇幼保健机构绩效管理

三级妇幼保健机构可通过绩效管理不断提升内涵质量。采用文献分析法和德尔菲法构建全面性与特异性、可操作性与敏感性相结合的医院内部绩效考核指标体系，包含前置要求、服务能力、服务质量、运行效率与成本控制、患者满意度5个一级指标、37个二级指标；同时搭建绩效监测与考核数字化平台，实现实时动态高效管理。经实践，医院服务能力、服务质量等方面不断提升。指出，建立标准化数据管理模式，充分发挥信息化优势，能够促进绩效管理精细化，持续提升妇幼医疗保健服务质量。     

全方位培训以提高医院外包保洁服务质量

目的:探讨提高医院外包保洁服务质量的方法。方法:分析医院外包保洁服务存在的问题和原因,并进行针对性及全方位培训。结果:培训后医院外包保洁服务满意度由88.70%提升为92.48%。结论:全方位的培训可以提高外包保洁质量。     

基于网络平台的医疗服务质量评价系统的设计与实施

目的：通过评价系统了解患者对医院医疗服务的认同程度及存在问题,为进一步改进服务质量提供依据。方法：设计开发评价系统,对与医疗服务质量相关的服务态度、服务质量、服务作风、服务价格、就医流程、环境卫生等内容进行评价。结果：系统可对医院整体、科室、个人3个层面的36项内容进行评测,并可录入意见和建议,从而客观反映患者对医院医疗服务的满意度。结论：医疗服务质量评价系统的应用,可及时反馈患者的意见,评测结果可帮助医院的管理者对医院、科室或员工的服务水准及存在问题进行判断和总结,从而进一步促进医院服务质量的提高。     

基于RBRVS与DRGs集成医院医师绩效体系的应用与探索

目的：推动公立医院高质量发展,推进管理模式和运行方式加快转变,提高医院运营管理科学化、规范化、精细化、信息化水平。方法：通过对DRGs的分组原则和方法进行分析,结合RBRVS绩效管理办法,确定绩效管理的相关指标及核算公式。结果：通过完整的绩效管理体系工具,激励医务人员在保障医疗质量的基础上,以扩大服务量、提高服务效率为目标,鼓励开展新技术、新项目,支持临床、教学、科研、疾病预防和管理齐头并进。结论：基于RBRVS与DRGs的绩效体系有效地提升医院医疗服务质量,推进医院绩效管理高质量发展,实现精细化管理和医疗技术创新目的。     

开展明星护士评选前后医院绩效评价

目的评价我院开展明星护士评选活动的具体成效。方法通过相关指标的对比，分析开展活动对增加住院医疗服务量和提高住院部工作质量和效率所起的作用；再利用综合绩效评价体系对活动开展前后六个年度医院综合绩效进行评价。结果活动开展前后工作量、质量及效率指标以及医院的综合绩效都有明显改善。结论评选明星护士活动带动了医院服务质量和服务水平的提高，为医院综合绩效的提升起到了重要作用。     

门诊医疗服务质量评价及医生的在职培训需求

对上海市区社区卫生服务中心（下简称为一级医院）与二级综合性医院（下简称为二级医院）门诊医疗服务质量与门诊医生在职培训需求的因素。结果显示：（1）门诊医疗服务质量得到了病人的认可,但医生有自我高估倾向;（2）要使所有门诊医生都有在职培训的需求,今后应采取综合措施;（3）应使继续医学教育更有实际价值。     

Lunasin is prevalent in barley and is bioavailable and bioactive in in vivo and in vitro studies

Lunasin, a unique 43-amino acid peptide found in a number of seeds, has been shown to be chemopreventive in mammalian cells and in a skin cancer mouse model. To elucidate the role of cereals in cancer prevention, we report here the prevalence, bioavailability, and bioactivity of lunasin from barley. Lunasin is present in all cultivars of barley analyzed. The liver and kidney of rats fed with lunasin-enriched barley (LEB) show the presence of lunasin in Western blot. Lunasin extracted from the kidney and liver inhibits the activities of HATs (histone acetyl transferases), yGCN5 by 20% and 18% at 100 nM, and PCAF activity by 25% and 24% at 100 nM, confirming that the peptide is intact and bioactive. Purified barley lunasin localizes in the nuclei of NIH 3T3 cells. Barley lunasin added to NIH 3T3 cells in the presence of the chemical carcinogen MCA activates the expression of tumor suppressors p21 and p15 by 45% and 47%, decreases cyclin D1 by 98%, and inhibits Rb hyperphosphorylation by 45% compared with the MCA treatment alone. We conclude that lunasin is prevalent in barley, bioavailable, and bioactive and that consumption of barley could play an important role of cancer prevention in barley-consuming populations.     

Salmonellas in pigs and animal feeding stuffs in England and Wales and in Denmark

A comparison has been made between the incidence of salmonellas in pigs and feeding stuffs in England and Wales and in Denmark. In Denmark there is veterinary legislation requiring the sterilization of imported and home produced feed ingredients of animal origin. There is no such legislation in England and Wales. In Denmark 0·3% of resterilized imported meat and bone meal was contaminated with salmonellas. This compared with 23% of meat and bone meal in England and Wales and 20-27% of other ingredients of animal origin. In England and Wales salmonellas were isolated from 7% of caecal samples and 6% of lymph node samples, while in Denmark they were isolated from 3% of caecal samples and 4% of lymph node samples. In England and Wales 25 serotypes were found in both pigs and feeds and these included nearly all the most prevalent human pathogens. In Denmark four of the six serotypes in pigs had been found in resterilized feed. One notable difference between the two studies was the very wide range of serotypes found in pigs in England and Wales and the narrow range in Denmark. A second was that Salmonella typhimurium formed 15% of all Salmonella strains isolated from pigs in England and Wales, and 60% of those in Denmark.     

Management of pregnancy and childbirth in England and Wales and in France

This paper reviews national data on obstetric and neonatal practices in England and Wales, and in France between 1970 and 1980. The data have been derived from national statistics and surveys on national samples of births in 1970, 1975 and 1980 in England and Wales, and 1972, 1976 and 1981 in France. The analysis shows that there was no major difference in pregnancy outcome, but wide variations in medical practices, and their trend over time. The main differences were: in England and Wales a higher number of antenatal visits, a higher percentage of inpatient admissions during pregnancy, a higher rate of induction, more episiotomies, a higher rate of resuscitation at birth, and admission to neonatal special care units; in France, a higher rate of caesarean sections before and during labour, some evidence of a more active management of labour, and a longer hospital post-natal stay. These differences in practice reflect differences in objectives and assessment of the effectiveness of care between the two countries: they point out the need for better monitoring and evaluation of obstetric and neonatal practices.     

Research and teaching in social and preventive medicine and in public health

Summary Both public health and social and preventive medicine are characterised by the common goal of promoting, maintaining and improving health and preventing disease, and both are concerned with a population-related, preventive and environmental perspective. But whereas public health is interdisciplinary and goes far beyond the medical focus, social and preventive medicine is medically based and forms a bridge between public health and medical practice. Research in a department of social and preventive medicine serves to support preventive and medico-social activities in medical practice as well as in public health. This is illustrated by results from research conducted at the author's department during the last twenty years. Examples are research in support of smoking cessation activities, and research used for the planning of care for the elderly. Both the research and the teaching activities of the department take into account the population focus of public health as well as the focus on individual medicine in clinical practice.

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Forschung und Lehre in Sozial-und Präventivmedizin und öffentlicher Gesundheit

Zusammenfassung Sowohl das Gebiet der öffentlichen Gesundheit als auch dasjenige der Sozial-und Präventivmedizin sind durch das Ziel der Förderung, Erhaltung und Verbesserung der Gesundheit sowie der Krankheitsvorbeugung gekennzeichnet, und beide beschäftigen sich mit einer bevölkerungsbezogenen, präventiven und umweltbezogenen Perspektive. Aber während die öffentliche Gesundheit stark interdisziplinär ist und weit über den medizinischen Fokus hinausreicht, ist die Sozial-und Präventivmedizin ein medizinisches Fach und stellt eine Brücke zwischen der öffentlichen Gesundheit und der ärztlichen Praxis dar. Die Forschung in einem Institut für Sozial-und Präventivmedizin dient der Förderung präventiver und sozialmedizinischer Tätigkeiten in der ärztlichen Praxis wie auch in der öffentlichen Gesundheit. Dies wird durch die Forschungstätigkeit des Instituts des Autors aus den letzten 20 Jahren illustriert, wobei Beispiele aus den Gebieten der Förderung der Raucherentwöhnung und der Betreuung behinderter Betagter dargestellt werden. Sowohl in den Forschungs-als auch in den Lehrtätigkeiten des Instituts finden der Bevölkerungsbezug der öffentlichen Gesundheit wie auch der individualmedizinische Ansatz der ärztlichen Praxis ihren Ausdruck.

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La recherche et l'ensignement en médecine sociale et préventive et en santé publique

Résumé La santé publique aussi bien que la médecine sociale et préventive sont caractérisées par le but commun de promouvoir, maintenir et améliorer l'état de santé et de prévenir les maladies, et elles s'orientent vers une perspective de population, de prévention et environnementale. Mais la santé publique est interdisciplinaire et va loin au-delà de la médecine, tandis que la médecine sociale et préventive est basée sur la médecine et représente le lien entre la santé publique et la pratique médicale. La recherche d'un institut de médecine sociale et préventive sert à appuyer les activités préventives et médico-sociales au cabinet médical aussi bien qu'en santé publique. Cela est illustré par des résultats de recherches conduites dans les vingt années passées à l'institut de l'auteur, et les exemples sont tirés de la recherche en appui de la promotion de la cessation de fumée et de la planification de la prise en charge des personnes âgées et handicapées. Les activités de recherche et de l'enseignement de l'institut tiennent compte de la perspective de population cacactéristique de la santé publique, aussi bien que de la dimension de médecine individuelle caractéristique de la pratique clinique.

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Paper presented at a symposium on The Public Health Perspective of Social and Preventive Medicine, in celebration of the 20th anniversary of the Department of Social and Preventive Medicine, University of Berne, 25 June 1992 in Berne.     

Eggs enriched in omega-3 fatty acids and alterations in lipid concentrations in plasma and lipoproteins and in blood pressure

Effects of dietary eggs enriched with omega-3 fatty acids on lipid concentrations in plasma and lipoproteins and blood pressure were determined in 11 men and women in two groups. Group 1 consumed four omega-3 eggs per day during the first 4-wk period and four control eggs for the second 4-wk period. Group 2 ate the same number of eggs in the reverse order. Mean plasma cholesterol concentration was significantly increased by control eggs (P less than 0.01) but unchanged by omega-3 eggs. Mean plasma triglyceride concentration was decreased by omega-3 eggs but increased by control eggs. Both systolic and diastolic blood pressures were significantly lowered by omega-3 eggs in group 1 whereas only systolic pressure was significantly decreased on omega-3 eggs in group 2. The control eggs did not change blood pressure. In conclusion, the omega-3 eggs may be more healthful than the control eggs.     

Selenium levels in human blood and tissues in health and in disease.

The levels of selenium in human sera and pancreatic, hepatic and synovial tissues were measured. An attempt was made to correlate the selenium level with certain disease states. Selenium was determined by nerutron activation analysis, using the 17.4 second half-life isotope 77mSe with a sensitivity of 2ppb. Serum-bound selenium was determined in normal individuals and individuals with various malignancies, and medical and surgical disorders. Tissue selenium was assayed in diseased and normal pancreases, livers, and synovial membranes. A wide variation was observed both in the serum selenium content of patients with a malignancy and in postmoren pancreatic and synovial showing histopathological changes. Significantly lower selenium values were observed in sera from cancer patients than from normal individuals. Higher values were generally observed in patients with primary neoplasms of the reticuloendothelial system. Higher tissue concentrations were obtained in synovia from patients with rheumatoid arthritis and in pancreatic tissues associated with histopathological changes.     

Prevalence and Trends in Overweight in Mexican-American Adults and Children

Overweight and obesity have been increasing in many countries. Our objective is to describe the trends in overweight and obesity occurring in the Mexican-American population in the United States. Data on measured height and weight for Mexican Americans come from the following surveys: the Hispanic Health and Nutrition Examination Survey (HHANES, 1982–84), the Third National Health and Nutrition Examination Survey (NHANES III, 1988–94), and NHANES 1999–2002. In 1999–2002, 73% of Mexican-American adults were overweight and 33% were obese. Obesity increased between NHANES III and NHANES 1999–2002, from 24% to 27% for men and from 35% to 38% for women. Increases were also seen for children and adolescents. The Mexican-American population in the United States, both children and adults, is showing trends in overweight and obesity over time that are similar to those seen in other segments of the U.S. population and indeed in many countries