医疗质量检查中存在问题及整改措施

医疗质量管理是医院管理的核心内容和永恒的主题,持续改进医疗质量和保障医疗安全是医疗质量管理的主要宗旨,医院应以病人为中心,以提高医疗服务质量为主题,以提高质量、强化安全、规范服务、降低费用为重点,把好医疗质量关,严格医疗核心制度,从而为患者提供优质安全的医疗服务,提高医院核心竞争力.     

加强和完善质量管理一把手工程建设

医疗质量是医院的生命,医院必须以医疗为中心,以医疗质量为重点,通过医疗质量管理使医疗活动的全过程处于最佳状态,达到医疗效果。在我国现行医院管理体制中,一把手是一个单位的核心,既     

医疗服务模式的理论界定及实践类型

医疗服务模式是指医疗服务提供者、医疗服务接受者和医疗服务管理者三方之间的制度化互动关系，医疗服务模式的核心内涵是影响医疗服务质量、价格和服务方式的权力关系。依据权力关系，医疗服务模式可以区分为两种基本类型：都以医疗服务管理者为核心的医疗服务模式和以医疗服务提供者为核心的医疗服务模式。     

分级医疗服务体系构建：国外经验与启示

归纳总结现行国际上较为成熟的分级医疗服务体系结构,分别介绍了发达国家和发展中国家的分级医疗服务体系建设情况,以基本医疗服务、二级医疗服务、三级医疗服务为常见的分层标准,认为构建分级医疗,应以基层医疗服务为主要内容,明确体系内部各级医疗服务提供方的功能定位以保障服务的连续性和非重叠性。     

医疗设备单机核算数据关联性探讨

医疗服务成本核算工作一直是困扰医疗主管部门、医院行政管理部门及医院财务科、设备科的一个核心难题.多年来各方一直在寻求一个切实有效的解决方案,为降低医疗服务成本,提高医疗设备的使用效率,付出了不懈的努力.随着医院HIS系统水平的提升,也为医疗服务成本核算提供了多种解决方案.本文结合医院的HIS系统、医疗收费系统、LIS系统、PACS系统、设备管理系统进行数据整合,得出部分真实可靠的医疗设备成本数据,为医院医疗成本核算提供决策参考,为进一步提升医疗服务质量提供决策依据.     

论美国对医疗行业的放松管制与再管制

为改善医疗行业绩效,美国在不同阶段对医疗行业进行了放松管制到再管制的改革。美国通过管理型医疗对医疗行业实施放松管制的政策。与受到严格管制的医疗行业相比,尽管通过管理型医疗引入竞争有利于控制医疗行业的运营成本,但同时可能会由于价格竞争导致医疗服务质量下降。为避免引入竞争带来的负面影响,美国对放松管制后的医疗行业进行了再管制。     

运用Ridit法综合评价我院医疗质量

目的 对我院近几年的医疗质量进行综合评价方法 采用Ridit法对我院2002-2009年各临床科室的医疗质量进行综合评价结果 标准组为0.5,值越大说明终末医疗质量越好.2002年值为0.573 1,医疗质量完成最好,2003年值为0.544 2、2004年为0.534 1、2005年为0.524 0、2006年为0.520 0、2007年为0.517 7、2008年为0.517 8,2003-2008年医疗质量接近整体水平.我院2009年值为0.5,因此2009年医疗质最差结论 Ridit法分析医院医疗质量简单、合理、直观,能够为医院医疗质量管理提供可靠的依据.     

医疗安全预警体系构建与信息化实现

医疗质量与患者安全已成为医院管理的首要重点,介绍了"以医疗信息化的发展为基础,应用医疗数据仓库和数据挖掘技术,构建医疗安全预警体系"的全过程和应用效果。信息化的医疗安全预警体系,为医院提供了新的管理依据,避免了医疗安全事件的发生,为现代医疗安全管理提供创新思路。     

盛京医院：贵在和谐——对话中国医科大学附属盛京医院院长郭启勇

一座有着127年历史的大型综合性医院,扎根大东北,坐落于辽宁省沈阳市,正在医疗服务中占有龙头作用,其就是享有品牌力量的盛京医院。盛京医院正以信息网络技术为平台,以提高医疗服务质量为核心,以方便患者就医为目的,整合不同水平的医疗资源,使优良医疗资源得到拓展和扩延,充分利用基层医疗资源,实现医疗资源的共享,带动各级医院的共同发展,满足人民群众日益增长的医疗需求。     

推行医疗风险管理提高医疗服务质量

为探讨医疗风险管理在医院医疗服务中的应用,本阐述了增强医疗风险管理的意识;医疗风险与医疗事故的关系;医疗风险与医疗质量的关系;医疗风险管理的积极性;医疗风险管理的制度;医疗风险管理的措施。为医院采用医疗风险管理提供经验。     

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.     

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.     

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.     

Bacteriology and constitutional health--genomics and proteomics: concepts in medicine and concepts in health insurance in the past and future

Future discussions on health issues on the individual or society level will be fundamentally linked to genetic dispositions. This genetic world will become reality in the same way the world of hygiene and bacteriology has become real for everyone. Approaches of molecular medicine for public health issues have not yet been created so far. The secret dreams of molecular eugenics must be made public and critically discussed. Up to now only a few monogenetically recessive hereditary diseases can be detected by screening. This kind of screening should be carefully considered. However, for the sciences, for medicine and thus for the physicians in practice, for health care sciences as well as for public health care, new tasks will emerge from genetics and molecular medicine. In individual as well as public health these new tasks will at first mainly turn in on the sphere of diagnosis and specific screening as well as health education and consultation. With regard to the considerable social implications the public health care sector should be aware of the coming issues of molecular medicine in time.     

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