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.     

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。     

时间管理在中医妇科专家预约门诊中的应用

总结时间管理在中医妇科专家预约门诊中的应用效果：通过对门诊流程及门诊专家、护士的时间管理,使门诊患者的候诊时间缩短,有效诊疗时间延长,保证专家诊疗时间高效利用和患者就诊有序及时,提高了患者的满意度。     

精神卫生中心普通门诊实施预约的效果

目的探索普通门诊实施预约流程的效果,以减少患者在门诊过程中不必要的等候时间,提高门诊整体服务水平。方法选取2010年4月20—24日及2010年10月12—16日到本院普通门诊就诊患者各250例,前时间段为对照组按一般门诊流程就诊,后时间段为研究组按预约后门诊流程就诊。采用自制问卷调查表调查两组患者就诊所花费的时间及对医院就诊环境的满意率。结果患者在门诊就诊各环节所花费时间的比较,研究组患者等候时间为（10．1±1．9）min,对照组为（48．4±4．7）min,两组比较差异具有统计学意义（t=119．45,P〈0．01）。对照组对软环境很不满意的3．0％,研究组为0．0％,两组比较差异有统计学意义（X^2=18．1,P〈0．01）。结论通过实施门诊预约的流程,有效缩短患者就诊的等候时间,体现人性化服务理念,提高门诊服务水平。     

目标化管理在提高门诊预约诊疗服务质量及患者满意度中的应用研究

目的 探讨目标化管理在提高门诊预约诊疗服务质量及患者满意度中的应用。方法 选取 2021 年 2 月至 2022 年 2 月期间 在本院接受常规门诊预约服务的 200 例患者作为研究对象。随机将患者分为对照组和观察组,每组各 100 例。对照组接受常规 的门诊服务;观察组实施目标化管理的门诊预约服务干预。分析对比两组的门诊服务质量、挂号及候诊时长以及护理满意度。 结果 观察组的工作态度、就诊环境、人文关怀、治疗效果、就诊秩序各项服务质量评分均显著高于对照组（P<0.05）。观察组 的预约挂号所需时长、线上预约候诊时长均显著低于对照组（P<0.05）;但两组的现场候诊时长无显著差异（P>0.05）。观察组 的就诊时间、预约流程、候诊时长、门诊服务、医护态度各项护理满意度评分均显著高于对照组（P<0.05）。结论 目标化管理 的门诊预约服务干预能提高门诊服务质量,减少挂号时长,提高护理满意度。     

多元化预约服务对门诊患者满意度的影响

目的:探讨多元化预约服务对门诊预约患者满意度的影响。方法:随机选取2015年11~12月门诊就诊患者150例为对照组,采用常规预约服务;随机选取2016年3~4月门诊就诊患者160例为观察组,采用多元化预约服务,比较两组患者的门诊候诊时间及门诊预约满意度。结果:观察组患者的门诊候诊时间短于对照组,差异有统计学意义(P0.05)。观察组的预约形式、预约方式、就诊流程、便捷性、服务态度、优先就诊等门诊预约满意率均高于对照组,差异有统计学意义(P0.05)。结论:多元化预约门诊服务能够有效减少门诊患者的候诊时间,提高患者对门诊预约的满意度,有利于实现优质护理服务。     

医院门诊诊间确费预约流程的建立与实施

目的探讨在医院门诊建立诊间确费预约的流程。方法 2011年5—6月上海交通大学医学院附属瑞金医院门诊实施诊间确费预约流程,通过计算机系统实时跟踪记录200例门诊患者从就诊开始至预约完成(包括排队等待)所耗费的时间,并与2010年12月—2011年3月200例患者所耗费时间进行比较,同时进行满意度问卷调查。结果实行诊间确费预约模式后,门诊患者需要耗费的平均时间为(8.27±3.30)min,平均缩短17.41 min;患者满意度从(71.30±4.41)%上升至(88.73±5.17)%。结论诊间确费预约模式能够大幅度缩短患者就诊、收费和预约流程的等待时间,显著提高了患者满意度,全面提升了医院的诊疗环境及医疗质量。     

“互联网+孕产妇群组”管理模式在门诊的应用效果

目的 探讨“互联网+孕产妇群组”管理模式在门诊的应用效果。方法 选取2020年11月至2021年4月传统就诊模式期间的孕产妇与2021年11月至2022年4月“互联网+孕产妇群组”管理模式运行时就诊的孕产妇作为研究对象。比较两时间段候诊时间、预约就诊率、产科门诊孕产妇满意度与孕妇学校听课人数。结果 传统就诊模式下候诊时间为(30.00±5.24)min,预约就诊率为73.2%,孕产妇满意度89.5分,孕妇学校听课数中位数为500人;“互联网+孕产妇群组”管理模式下候诊时间为(17.00±3.09)min,预约就诊率为86.3%,孕产妇满意度93.7分,孕妇学校听课数中位数为665人。结论 “互联网+孕产妇群组”管理模式能缩短候诊时间,提高门诊工作效率,提升门诊医疗服务质量。     

医院门诊部有效接触点服务的管理

目的探讨医院门诊部服务中，通过对门诊患者进行有效的“接触点”服务及对接触点服务质量的控制，以达到提高医院门诊的服务质量。方法通过调查确定患者在门诊就医的有效“接触点”，即对就诊环境、后勤、窗口服务、医务人员等有效接触点服务进行质量控制并制定各种服务规范。评价实施有效“接触点”服务及对接触点服务进行质量控制后的效果。结果有效“接触点”服务实施前后患者在就诊环境（65．0％比84．1％），注射时满意度（87．8％比98．3％）等方面比较，差异有统计学意义（x。分别为35．99，31．51；P〈0．05）；医疗投诉较2009年下降35％。结论门诊管理者掌握门诊患者有效“接触点”服务，针对性地加强“接触点”服务管理，能有效提高医院门诊服务质量和患者满意度。     

基于JCI标准的门诊患者非技术质量服务满意度调查

目的调查门诊患者对非技术质量服务的满意度情况,为改进医院门诊服务提供依据。方法选取1200例门诊患者为研究对象,采用自行设计的问卷对其进行问卷调查,统计患者对服务态度、服务流程、告知服务、保护隐私及环境的满意度并进行分析。结果共收回问卷1083份。问卷项目应答率为94．32％。预约人员及医生服务态度的满意度达到90％以上,其余7个岗位人员均低于90％。其中就诊医生的满意度最高为95．6％,挂号缴费人员满意度最低为80．6％;患者对各流程的等候时间满意度均低于80％,最低的是等候取药时间为50．9％;患者对药师告知服务的满意度最高为94％,对护士告知服务满意度最低为90．2％;患者对医生保护隐私的满意度最高为95．3％,对检查科室人员保护隐私的满意度最低为86．3％;患者对医院门诊环境安全的满意度最高为88．4％,对环境卫生的满意度最低仅71．2％;患者对不同工作人员服务态度、告知服务、隐私保护及不同服务流程的满意度差异有统计学意义（x2分别为13156．84,3005．25,6828．696,4957．269,3110．284;P均〈0．05）。结论患者的感受及满意程度是医院改善非技术质量服务的重要依据,医院应最大限度满足患者合理化需求,不断努力提高医院整体医疗服务质量。     

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.     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.