特勤人员疗养采用临床路径管理的探讨

临床路径是管理工作中的一种模式,它集诊疗、护理、服务、协作、沟通等诸要素于一体,做最恰当、最有序、最有时间性的计划,疗养员由入院到出院依此来接受服务,从而控制环节质量,节约资源,缩短时限,使疗养员获得最满意的服务.特勤人员是特殊群体,其身体素质要求是决定能否顺利完成卫勤任务的保证.他们在疗养期间的保障是新时期军事斗争卫勤准备的重要组成部分.疗养院如何完成联勤体制下的保障任务,是我们面临的重要课题,也是深化联勤体制改革的重要内容.笔者认为,在现有体制下有效避免矛盾,将临床路径有效应用到特勤疗养的管理中,探索出一条适合特勤疗养的模式,从而达到消除疲劳,矫治疾病,增强体质,使身心健康得到全面提高的目的.     

The clinician effect on "objective" technical components of the electrodiagnostic consultation

OBJECTIVE: To examine the impact of clinician factors on technical data within an electrodiagnostic consultation for low-back pain and spinal stenosis. DESIGN: Examiner differences on single-segment paraspinal mapping scores and other findings were examined in a prospective, masked, double-controlled trial involving 150 people aged 55-80 yrs who were selected for no symptoms, back pain, or possible spinal stenosis. RESULTS: Unmasked clinicians were more variable than masked physicians (F2,219 = 4.808, P =or<0.01) and gave lower scores to people they felt had mechanical back pain. The percentage of inadequate segmental scores differed among clinicians (0-16.6%, F8,226 = 4.170, P < 0.001), with fellows having more difficulty than faculty (11.76 +/- 32.38% vs. 0.75 +/- 8.67%) (t233 = 3.753, P < 0.001). Correction of clinician bias improved the relationship between paraspinal score and subjects' ability to walk (weighted regression R = 0.129, B = -0.047, P < 0.001; unweighted regression R = 0.090, B = -0.045, P < 0.001). CONCLUSIONS: Objective testing is adversely affected by clinician factors including prejudgment, experience, and individual idiosyncrasies. Less variation is found in more codified procedures. For electrodiagnostic consultation, correction of variability improves the relationship of test results to disability.     

精细化管理在护理技术操作中的应用

精细化管理是源于发达国家的一种管理理念,它是服务质量的精细化对现代管理的必然要求,建立在常规管理的基础上,并将常规管理引向深人的关键一步,体现了管理过程中精心是态度,精细是过程,精品是成绩,实现人人都管理,处处有管理,事事见管理[1].     

精细化管理在护理技术操作中的应用

精细化管理是源于发达国家的一种管理理念,它是服务质量的精细化对现代管理的必然要求,建立在常规管理的基础上,并将常规管理引向深入的关键一步,体现了管理过程中精心是态度,精细是过程,精品是成绩,实现人人都管理,处处有管理,事事见管理^[1]。     

惩罚原则在护理管理中的应用

笔者报道在抓各项制度落实、技能培训、人性化管理的基础上应用惩罚原则以提高护理质量。着重通过避免惩罚不足原则、及时惩罚原则、重现原则、核查事实、惩罚的标准要一致等来改变护士的不良行为,增强护士的自觉性,统一护士的行为。2003年惩罚原则应用后,护士迟到早退、抽血凝固、被病人投诉均比应用前的2002年减少,病人满意度提高,经字2检验,有显著性差异,或说明惩罚原则可以改变护士不良行为提高护士的技术水平和病人的满意度减少病人的投诉     

"住院护士"在护理管理中的作用

在专科护理管理实践中,为保证夜间护理质量得到有效的控制与管理,通过在年轻护士中实施"住院护士"制度,有效地提高了科室的夜间护理质量,保证了夜间危重病人的护理安全,做好夜间的过程管理控制和夜间病区协调管理,合理运用有限的人力资源,调动了年轻护士的积极性,提高了护士的综合素质,对科室的护理安全和护理质量起到了积极的促进作用.     

Fiberoptic "awake" nasal intubation: physiological and personal concepts

Use of fiberoptics is gaining in popularity, particularly in neurosurgery. Advantages of use of FNI for the patient with neurological dysfunction include: minimized increases of ICP; decreased use of opiates; reduced manipulation of the spine; direct visualization of the respiratory tract.     

A physician's guide to personal stress management

Physicians are at increased risk for many of the adverse consequences of stress. This paper discusses common sources of stress and presents strategies for coping with them. Indications for more individualized treatment with a mental health specialist are also discussed. The author has stated that he does not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article.     

"Low-tech" personal emergency response systems reduce costs and improve outcomes

A relatively inexpensive low-technology solution can be used by managed care organizations (MCOs) to improve outcomes and significantly reduce health care costs among community-residing elderly patients. Clinical studies indicate that usage of monitored Personal Emergency Response Systems (PERS) reduce mortality rates by nearly four times, reduce hospital utilization by 59 percent, and yield a positive benefit-to-cost ratio of over seven to one (every dollar spent on PERS results in $7.19 in health care cost savings).     

The role of interagency collaboration in "joined-up" case management

This article reports on research into the relationships that a group of case managers formed with local service providers in order to deliver integrated, "joined-up" services to young people experiencing homelessness and unemployment in the state of Victoria, Australia. Using a two-part customized survey tool, we explored the number and nature of relationships with other agencies. Two focus group discussions contributed to the interpretation of the survey findings. We found that these case managers maintained many relationships, mostly with housing and employment service providers. These relationships were predominantly cooperative in nature, and most could not easily be characterized as collaborative. Our research supports the view that, in an increasingly complex social service system, other forms of cooperation are usually appropriate for achieving the types of interorganizational relationships that are important to assist shared clients. Furthermore, this research supports the notion of a relationship continuum, finding that ratings of relationship elements were positively correlated with relationship type. This research indicates the importance of considering the pragmatic, contextual and situated practices that comprise interagency relationships, their fitness for purpose and the importance of cooperation for effective service provision.     

Lessons learned in public health emergency management: personal reflections

Multiple environmental, ecological, and socio-political forces are converging to increase the occurrence of both natural and technological disasters. Ten forces are of most concern in this regard. These are: 1) global warming, with its consequent weather extremes and climate changes; 2) continued rapid human population growth and concomitant increased urbanization; 3) decreased bio-diversity and consequent ecological fragility; 4) deforestation and loss of natural habitat for animal species, with resultant greater overlap of human and animal habitats, human exposure to animal pathogens, and other ecological perturbations; 5) increased technological development throughout the world (especially in developing countries with their typically immature safety programs); 6) globalization and increased population mobility; 7) sub-national religious and ethnic conflicts, and their potential for conflict escalation and large scale displacement of populations; 8) the collapse of several major countries and consequent unraveling of national identity and social order; 9) the rise of terrorism; and 10) dramatic advances in the science and technology of computing, communications, biotechnology, and genomics. This paper describes 10 lessons learned relative to the public health aspects of emergency management, especially as they pertain to disasters. 1) Planning pays; 2) A bad situation can be made worse by inappropriate responses; 3) Most life saving interventions will occur before the disaster happens and immediately afterwards by local action; 4) Public health emergency management is not a democratic process; 5) Psychological impacts are usually greater than anticipated; 6) Communications and information management are vital, but often are the weak link in the response chain; 7) Collaboration and partnerships are essential; 8) Unsolicited volunteers and aid are inevitable and must be planned for and managed; 9) Never assume anything, and always expect the unexpected; and 10) Post-event evaluation is important, and must be coordinated. The paramount lesson learned from past emergencies is that the untoward impact of these events can be anticipated and significantly ameliorated by appropriate planning and preparation. On the other hand, preparation for emergency events has deteriorated because of health-care financial constraints, and resources to support planning and needed infrastructure have diminished. Given these realities, the major unresolved challenge is how to ensure that planning for the common good is supported and, in fact, gets done.     

“6S”管理在提高护理质量管理中的实践与应用

[目的]探讨"6S"管理在提高护理质量管理中的应用.[方法]对病区环境进行现场调查评估,运用"6S"活动的常用方法,即目视管理、定置管理、定期审核对病区环境、护士仪表仪容、药品管理、办公室管理、表格书写、基础护理、仪器设备、治疗室管理、服务态度、护理安全等10个方面进行考核评价.[结果]通过"6S"管理,医护人员及病人住院环境得到改善,医疗护理工作效率得到提高,病区环境,物品的分类、定点放置规范,达到目视管理的要求;其次提高了护理人员对医疗安全风险防范的意识,降低了劳动成本,避免了浪费,保证了工作质量,提升了医院形象.[结论]护理质量管理中应用"6S"管理效果明显.     

新型冠状病毒肺炎防控期间重症病区个人防护与消毒隔离的措施管理

自2019年1月武汉新型冠状病毒肺炎发生以来,医院院感防控这一公共卫生问题进入公众视线,同时也切实关系到临床一线医务人员的健康问题。本文总结我院新型冠状病毒肺炎防控期间重症病区医务人员个人防护与消毒隔离的措施管理,旨在提升医务人员防护能力及切断传染病的传播途径。