全“心”康复全新旅程——连续性医疗模式下心脏康复的发展与探索（二）

和睦家引进康复服务致力打造连续、全面医疗服务,据北京和睦家医院盘伸莹院长介绍：和睦家医疗作为外资医院的领跑者,在中国16年以来,已在北京、上海、天津和广州设立了医院及诊所,提供一流的、高质量的国际标准医疗服务。在这16年里,和睦家从服务理念到临床上进行了许多探索和创新。连续性医疗服务是和睦家一贯倡导和致力打造的医疗先进模式。近年来,和睦家在现有综合医院治疗、家庭医疗保健的基础上,引入康复专科服务理念,填补了医院治疗和家庭医疗保健之间患者疾病急性期后但仍需要医疗康复专业服务的空白,把康复纳入到保健、诊断、治疗的一系列医疗服务中,既是‘保健一诊断一治疗一康复”的连续性医疗模式的最终形成。     

《关于进一步加强综合医院中医药工作推动中西医协同发展的意见》解读

正综合医院是提供中医药服务的重要平台,是中医药传承创新的重要阵地,加强综合医院中医药工作对坚持中西医并重、促进中医药和西医药相互补充、协调发展具有重要意义。为深入贯彻习近平总书记关于中医药工作的重要论述,加强综合医院中医药工作,国家卫生健康委、国家中医药局、中央军委后勤保障部卫生局联合制定了《关于进一步加强综合医院中医药工作推动中西医协同发展的意见》(以下简称《意见》)。《意见》立足于当前综合医院中医药工作特点和实际情况,从八个方面提     

全“心”康复全新旅程——连续性医疗模式下心脏康复的发展与探索（三）

北京和睦家康复医院（BJURH）是和睦家医疗致力于打造连续性医疗服务的一个重要里程碑。作为和睦家医疗集团第一家专科医院,康复医院致力于为全球范围内需要功能康复的人群提供卓越的康复治疗服务,已于今年6月底正式投入运营。秉承和睦家医疗的高品质,高标准,借鉴东西方医学康复的精髓,北京和睦家康复医院拥有励建安教授率领的国际化康复医疗团队,世界一流的康复治疗设施,以及温馨舒适,家一样感觉的就医环境。在JCI医疗质量体系的基础上,北京和睦家康复医院将遵循CARF质量论证体系,建立和执行与康复有关的质量控制系统,并致力于成为中国第一家CARF认证医疗机构和CARF体系的样板医院。     

广西三江侗族自治县人民医院

广西三江侗族自治县人民医院成立于1953年，近年来，医院取得了长足的发展，医疗技术稳步提高，院容院貌焕然一新，成为三江县唯一一所集医疗、科研、教学、预防、保健服务为一体的二级甲等综合医院和爱婴医院。     

广西三江侗族自治县人民医院

广西三江侗族自治县人民医院成立于1953年，近年来，医院取得了长足的发展，医疗技术稳步提高，院容院貌焕然一新，成为三江县唯一一所集医疗、科研、教学、预防、保健服务为一体的二级甲等综合医院和爱婴医院。     

探讨基层三级综合医院门诊现代化建设及管理

基层三级综合医院多为地市级三甲医院,在当地承担着重要的医疗卫生服务。随着经济的发展,人民生活水平的提高及国家医保、新农合等医疗福利的不断提高,基层三级综合医院就诊患者每年都有大幅度的增加,门诊就诊患者甚至以倍数级增加。不断增加的医疗服务需求对现代化医院提出了新的要求。如何建设及管理好门诊成为医院现代化建设重要的一部分。我院近2年新建了门诊部,并实行了信息化管理,优化了门诊就诊流程,有效地解决了日益增长的医疗服务需求,本文就我院门诊建设及管理取得的成效分析如下。     

中国肿瘤医院和三级医院院长关于缓和医疗服务的全国性调查

目的 从医院领导角度了解并比较我国肿瘤专科医院和三级医院的缓和医疗服务现况。方法 对肿瘤医院(206家)和三级医院(443家)领导进行缓和医疗服务的电子问卷调查并比较两类医院是否存在差异,调查内容包括服务形式和内容、未来计划以及阻碍学科发展的因素等。采用SPSS 16.0软件进行数据分析。根据数据类型,组间比较分别采用t检验、Fisher确切概率检验及χ²检验。结果 全国共88家(42.72%)肿瘤医院和174家(39.28%)三级医院领导完成调研,肿瘤医院参加调研的比例明显高于三级医院(P<0.01)。过去10年,78.74%(137/174)的三级医院和85.23%(75/88)肿瘤医院都能提供缓和医疗服务;目前仍能提供这一服务的比例分别为87.59%(120/137)和90.67%(68/75),差异均无统计学意义。48.53%(33/68)的肿瘤医院以及40.83%(49/120)的三级医院有缓和医疗专科医师(P=0.31)。肿瘤医院的专科门诊率为27.94%(19/68),三级医院为17.50%(21/120),差异无统计学意义;肿瘤医院在会诊[29家(42.65%)和33家(27.50%)]、住院床位[28家(41.18%)和32家(26.67%)]、专属安宁疗护机构[20家(29.41%)和20家(16.67%)]情况方面,均较三级医院有显著优势(P<0.05)。在缓和医疗服务和镇痛治疗上,两类医院都比5年前有显著进步(P<0.01);对缓和医疗与肿瘤治疗整合的观点都很支持,肿瘤医院均值为(7.06±3.19)分,三级医院为(6.29±3.64)分,差异无统计学意义;肿瘤医院对增加科研项目的赞同度显著高于三级医院[(7.24±3.12)和(5.91±3.71)分,P<0.01]。阻碍缓和医疗服务的前三位因素依次为缺乏报销支持、专业人员和预算。结论 尽管全国85%以上的肿瘤医院和三级医院提供服务,但缓和医疗专科医师的比例不足50%。两类医院的缓和医疗及镇痛治疗都有显著进步,而肿瘤医院在专科会诊、住院床位、安宁疗护机构上比三级医院有优势。缺乏报销支持、专业人才和预算为阻碍缓和医疗服务的三大因素。     

新泰市中医院简介

新泰市中医院始建于1990年,是一所集中医、医疗、教学、科研、急救、康复、保健为一体的三级甲等中医院。是山东中医药大学医疗集团常务理事单位、山东中医药大学附属医院协作医院、青岛大学医疗集团新泰分院、泰山医学院附属医院技术协作医院、华东地区结石病防治基地——山东第三基地、山东省中医药预防保健服务中心、新泰市中医药技术服     

名老中医药专家宝贵经验的传承方式思考

新中国成立以来,中医、中西医结合事业取得了前所未有的卓越成果,形成了独具特色的理论、研究方法体系及强大的科研、临床队伍,现代中医药教育为培养了一大批优秀的中医人才,但现阶段仍存在中医药教育和科研、临床需求部分脱节,中医医疗、科研机构数目较少、力量不强,中医药专业毕业生就业困难等问题,名老中医药专家师承制度的推广,是提高新一代中医药从业者临床、科研、就业能力的一条捷径,也有符合长期以来传统医学培养的模式,有利于传承名老中医药专家的宝贵经验,发掘抢救中医药瑰宝。     

《湖南中医杂志》2005年征订启事

《湖南中医杂志》是由湖南省卫生厅主管、湖南省中医药研究院主办的综合性中医药学术期刊。近几年连续被评为全国优秀科技期刊、全国中医药优秀期刊、中国中文核心期刊、湖南省优秀科技期、湖南省一级期刊。本刊以面向临床、面向基层为宗旨。辟有论著、经验总结、老中医经验、中医急症、学术探讨、针灸医学、中医研究、疑难杂症、医案医话、中医护理、短篇报道、单方验方、实验研究、医院管理、诊余反思、文献综述、晋升辅导等栏目,适合于从事医疗、科研、教学各个层次读者的需要。2005年仍大16开,每期64～80页,信息量大。本刊为双月刊,逢单…     

154例特需中老年住院患者反应性调查与分析

目的 通过对特需中老年住院患者反应性调查与分析，了解特需医疗服务的优势及需要改进之处，为提高工作绩效和整体决策提供科学依据。方法 采用随机抽样方法对上海市某三甲医院154位特需中老年住院患者进行了匿名式问卷调查。结果 特需中老年住院患者反应性总体评分高于上海市卫生系统反应性评分。结论 特需服务充分体现出高端医疗市场的定位，其优质、人性化的服务与需求者的期望基本符合。提高特需住院患者反应性，将有利于促进医院提高非医疗服务的质量。     

Inappropriate hospital utilization for long-stay patients in southern Taiwan

This study examined the inappropriate utilization of hospital services under the National Health Insurance (NHI) program. The study population consisted of long-stay inpatients who stayed longer than 30 days in acute care hospitals located in southern Taiwan. The study hospitals included four medical centers, six regional hospitals, and 21 district general hospitals. The survey of patients was conducted in January and May of 1996 using the Acute Care Hospital Long-stay Questionnaire developed by the research team. Excluding subjects with missing values and abnormal length of stay, 536 long-stay patients were included in the analysis. Among these, 196 patients (36.6%) were classified as having an inappropriate stay, while 340 patients (63.4%) had an appropriate stay. Of the long-stay patients in medical centers, 32.2% were inappropriate stays; this figure was 45.4% for regional hospitals and 43.3% for district general hospitals. There were significantly higher proportions of inappropriate long-stay patients in regional and district general hospitals than in medical centers. In conclusion, this study confirms the existence of inappropriate hospital bed days, which may be due to patient characteristics, hospital factors, and NHI payment schemes. If the NHI program can provide incentives to long-stay patients who no longer need acute care to move, patients' utilization behaviors might change and hospital discharge plans could be modified for more efficient utilization of hospital beds.     

Australian resident doctors want more palliative medicine education: a survey of attitudes and perceived needs

Most expected deaths occur in acute hospitals, and medical staff providing end-of-life care are generally not palliative medicine specialists. Through a voluntary self-administered survey, this study explored resident doctors' attitudes to palliative medicine and their perceived educational needs. Fifty-two resident doctors participated (response rate 39%), mostly acknowledging the importance of palliative medicine to their practice and emphasising that further postgraduate education is necessary.     

Procedures requiring signed consent. A survey of practice

Despite extensive discussion of informed consent within the medical and legal literature, those diagnostic or therapeutic procedures which may specifically require written consent remain poorly identified. Survey results from 105 JCAH-approved hospitals show that 56 percent set forth a general policy statement regarding when and for which procedures consent is needed. The remaining hospitals specify individual procedures for which signed authorization is required by the hospital or medical staff guidelines. The potential liability, advantages and disadvantages of a general versus specific consent practice are discussed. A listing of those procedures itemized by responding hospitals from this national survey is also presented.     

Medical activity of the French internal medicine departments in 2000-2001 from the DRG system

PURPOSE: Medical activity of the French Internal Medicine Departments has been described until now only by limited declarative surveys. The aim of this study was to describe this activity using the French DRG system. METHODS: A postal survey was conducted using the list of the French Society of Internal Medicine. The same questionnaire was posted to 212 departments (university, public and private hospitals) to collect the 2000 or 2001 data from the DRG system. RESULTS: 192,197 reports were analysed. One hundred and eighty four groups were listed on a theoretical number of 313 medical groups. The first 10 groups concerned common general diseases (pneumonia, anaemia, heart failure, diabetes, stroke.). The main difference between university and non-university hospitals concerned the management of systemic diseases, which was more frequently quoted in university hospitals. Benign and malignant haematological diseases and oncology were frequently quoted in both types of hospitals. CONCLUSION: This study allows for the first time in France to have an objective survey of the medical activity of Internal Medicine Departments. It confirms that these departments have a central role in the hospital management of current diseases but also of haematological diseases and cancer. University departments are more specifically implicated in the management of systemic diseases.     

Collaboration between university hospitals and local medical communities in Japan evaluated by a questionnaire among doctors

AIM AND METHODS: To provide quality medical service in a society with many elderly, university hospitals should clearly define their roles and contribute to the establishment of an integrated, comprehensive medical system. In this study, we conducted a questionnaire survey of doctors working at Kyoto University Hospital and at private practices in Kyoto about their attitude toward collaboration between the university hospital and private practices and asked their opinions on the role of university hospitals in the local medical community. RESULTS: The survey showed that doctors both at the university hospital and in private practice regarded close collaboration as important, but also highlighted obstacles and problems that block collaboration. CONCLUSION: Overcoming these problems and constructing collaboration models will be a key for university hospitals to fully contribute to the establishment of a quality medical system.     

北京协和医院普通内科2004-2008年住院患者构成分析及大型综合医院设置普通内科的价值初探

目的 总结北京协和医院普通内科2004-2008年收治住院患者的构成特点,初步探讨普通内科在大型综合医院设置的必要性.方法 回顾性分析2004-2008年北京协和医院普通内科住院患者的资料(患者来源、入院诊断、出院诊断等).结果 期间普通内科住院患者共2593例,其中男1075例,女1518例,平均年龄45.1岁.入院时诊断不清者占64.9%(1683/2593),其中不明原因发热(FUO)758例,非FUO待查病例925例.FUO最终明确诊断率89.2%(676/758),疾病前3位是肌肉骨骼系统和结缔组织疾病226例(29.8%)、传染病和寄生虫病199例(26.3%)、肿瘤110例(14.5%).非FUO的待查病例最终明确诊断率86.8%(803/925),疾病前3位为肌肉骨骼系统和结缔组织疾病230例(24.9%)、肿瘤143例(15.5%)、血液及造血系统疾病105例(11.4%).出院诊断共涉及550个病种.结论 北京协和医院普通内科住院患者具有来源广、疾病种类多、诊断不清比例高等特点.普通内科既解决了诊断不清等患者的收治问题,又为年轻医(学)生提供了良好的医学教育平台,体现了大型综合医院设置普通内科的必要性.

Abstract：

Objective To analyze the disease spectrum of patients admitted to the General Internal Medicine Unit at Peking Union Medical College Hospital, which is the first academic division of general internal medicine in the department of medicine within Chinese medical colleges and universities, and the value of general internal medicine unit in comprehensive hospitals. Methods A retrospective data review of patients admitted to the General Internal Medicine Unit from 2004 to 2008 was conducted from hospital information system and partially by chart review manually. Analysis of disease spectrum was performed thereafter. Results A total of 2593 patients were included in our study. It consisted of 1075 men and 1518women, with an average age of 45.1 years old. Forty point three percent of these patients were from Beijing,the local city, and the remaining 59.7% were from outside of Beijing. Sixty-four point nine percent (1683/2593)of these patients did not have a clear diagnosis on admission, including 758 fever of unknown origin (FUO) cases and 925 non-FUO cases. The final diagnostic rate of the FUO cases was 89. 2% [676/758, with the first three leading causes as diseases of the musculoskeletal system and connective tissue (29. 8%), certain infectious and parasitic diseases(26.3%), and neoplasm (14. 5%)] . The final diagnostic rate of the 928 non-FUO cases was 86. 8%(803/925), with the first three leading causes as musculoskeletal system and connective tissue(24.9%), neoplasm (15.5%), and diseases of blood and blood-forming organs(11.4%). Despite most diagnoses fitting into the above categories, the array of diseases was broad with as many as 550 discharge diagnoses from 2004 to 2008. Conclusions During 2004 -2008, there was a high proportion of cases that presented to the General Internal Medicine Unit at Peking Union Medical College Hospital with an unclear diagnosis, and the spectrum of diseases diagnosed was very broad. This kind of patient admitting model might not only benefit patients with no clear admission diagnosis and patients with multidisciplinary medical problems for whom it is usually difficult to be admitted by a specialty unit, but would also benefit medical students and residents by providing a good clinical medicine teaching base. These features show the value of general internal unit in comprehensive hospitals.     

广西柳州市公立医院医师执业满意度调查及其影响因素分析

目的了解柳州市市属公立医院医师执业满意度及其影响因素。方法采用分层随机抽样的方法抽取柳州市市属9家二级及以上公立医院的306名执业医师作为调查对象。采用问卷调查的方式了解其对执业的满意度,分析影响医师执业满意度的相关因素。结果54.58%(167/306)的执业医师对当前的执业环境感到满意。当以医院级别、年龄、性别、文化程度、科室、职称、每周工作时间及聘用形式进行分组时,组间满意度得分差异有统计学意义(P<0.05)。二分类Logistic回归结果显示,认为医师行业的整体形势会变更好、表示非常喜欢医师这个职业及表示没有产生过转行的想法等10个条目特征的医师总体满意度较高(P<0.05)。结论广西柳州市公立医院医师执业满意度居于一般水平,应加强医疗资源的优化配置、推行分级诊疗制度、完善薪酬制度及创造和谐的工作环境,以提升医务人员的执业满意度。     

Collaboration between university hospitals and local medical communities in Japan evaluated by a questionnaire among doctors

Background:   To provide quality medical service in a society with many elderly, university hospitals should clearly define their roles and contribute to the establishment of an integrated, comprehensive medical system.
Methods:   In this study, we conducted a questionnaire survey of doctors working at Kyoto University Hospital and at private practices in Kyoto about their attitude toward collaboration between the university hospital and private practices and asked their opinions on the role of university hospitals in the local medical community.
Results:   The survey showed that doctors both at the university hospital and in private practice regarded close collaboration as important, but also highlighted obstacles and problems that block collaboration.
Conclusion:   Overcoming these problems and constructing collaboration models will be a key for university hospitals to fully contribute to establishing a quality medical system.     

Acute hospital medicine in Ireland — past,present and future

The twentieth century has seen enormous changes in the practice of medicine, and as it becomes ever more successful, demand for acute hospital treatment can only increase. For political reasons the growth of Ireland's hospital service has been erratic and poorly planned. There are, therefore, still Irish hospitals in which acute general medicine is practised without subspeciality support by a dwindling number of general physicians. These physicians and their medical units care for more than half of the 140 000 acute medical admissions/year to Irish hospitals. Most Irish general medical units are efficient with short length of stays compared with other specialities, and low levels of inappropriate admissions by international standards. However, fundamental problems have developed in Irish post-graduate medical education, which are presently seriously lowering morale throughout the profession. Although the number of hours worked has recently been decreased considerably, the proportion of hours spent doing nonmedical menial and clerical work has increased, with a corresponding decline in the number of hours spent in productive patient-related training. As a result, clinical training has become far less satisfying at every level: professional, educational and emotional. Despite the fact that manpower statistics predict an oversupply in the near future, young Irish physicians still continue to seek subspeciality training and show little interest in acute hospital medicine. A major cause of this paradox is the lack of general physician role models in Irish academic centres. The provision of medical service to the population at large is the medical problem of our age: it is undoubtedly true that in the past, many physicians acquired much of their skill by a process of trial and error, often at the expense of their patients. The challenge for the future will be how to recruit and train the next generation of general physicians safely and appropriately.