妇幼卫生专业的社区教学实践的尝试

通过以社区为范围，家庭为单位，开展首届妇幼卫生专业的学生进行社区教学实践的尝试，探讨改进妇幼卫生专业教学实践的方式。作者认为，妇幼卫生专业的教学必须与社区实践结合起来，而且对被观察的孕产妇必须进行较长时间的随访，同时结合所学的知识，运用到实际工作中，使学生能真正掌握所学到的知识；社区为妇幼保健的教学提供了一个良好的实践环境，把教学放在社区进行，不仅使学生学到书本上学不到的知识，更重要的是满足社区群众的基本卫生服务需求；开展社区教学实践，将开拓学生的知识视野，拓宽学生的思维和观察能力，树立为社区服务的思想。建议今后妇幼卫生专业采取不定期的教学，要以社区作为教学的实践基地，并扩大社区服务范围，创造优良的教学实践环境，为提高学生的综合素质及能力奠定基础。     

医院学科带头人的选拔和任用

为探讨医院学科带头人的选拔和任用的经验，本阐述了选拔任用学科带头人必须坚持政治和知识能力的高度统一；必须建立科学的考评机制；必须处理好几个关系。     

加强科管人员综合素质培养为科技人员提供优质服务

为医学科技人员提供优质的服务是医学科管人员神圣的职责，而科管人员的综合素质决定着服务水平的高低。一名优秀的科技管理人员，必须加强以下几方面的素质培养：牢固的服务意识；较强的组织协调管理能力；快速获取信息的能力；全面的流行病学及卫生统计学知识；较强的语言文字表达能力和与人沟通的能力。要努力使自已成为除科管知识外具较广泛科技知识的“T”型知识和能力结构的复合型人才，才能为广大的医学科技工作者提供最优质的服务，为医学科技事业做出贡献。     

继续医学教育创新谈

文章从三个方面，对继续医学教育如何跟进时代并有所创新进行论述。首先是观念上的创新，而观念创新的着重点在于：一是培养创新能力；二是培养复合型人才；三是培养人文素质。其次要在教育内容上创新，主要内容：一是着眼于整体素质的培养；二是注重多学科知识交叉学习；三是提倡有选择性学习。再者是教育手段和方法创新：一是发挥教育技术的作用；二是使受教育者由被动变主动；三是采用开放式的学习方法。     

关于中医基础理论重点学科建设问题的讨论

基础理论学科的知识创新与重点学科的建设工作密切相关，知识创新的技术平台建设主要依赖于学科发展方向、学术带头人、学科人才梯队和运行管理机制的建设。关注学术发展动态。拟定高起点、高水平的学科发展方向；根据科学发展趋势，选拔开拓进取、勇于创新的学科带头人；瞄准科学前沿，建立多层次、结构优化的学科人才梯队；创新管理模式，实行科学化运行机制和管理体制是保障知识创新的前提和基础。     

依据"三个代表"推进医院建设

医院如何全面落实“三个代表”重要思想，推进改革与创新，本提出：一是必须强化与时俱进的思想观念，进一步坚持在解放思想中统一思想，为医院的创新与发展提供强大的思想保证；二是必须强化党的先进性的观念，进一步加强党委支部建设，为医院全面建设的创新与发展提供坚强的组织保证；三是必须强化坚持执政为民的观念，进一步坚持姓军为兵的方针，为医院全面建设的创新与发展提供正确的方向保证；四是必须强化人是生产力发展第一要素的观念，进一步加强人才队伍建设，为医院全面建设的创新与发展提供有力的人才保证。     

惟有创新才能实现医院跨越式的发展

本文探讨了医院跨越式发展的内涵和实现医院跨越式发展的基础及必要性，提出了医院实现跨越式发展惟有创新，包括：(1)观念创新；(2)市场创新；(3)体制创新；(4)服务意识创新；(5)内部结构创新；(6)支持与辅助部门资源重组；(7)适应WTO的挑战；(8)知识创新。     

试论医院的技术引进和创新

提出了以技术引进结合二次创新为主，科研开发为辅，充分挖掘现有技术潜力的管理原则；指出：①人才素质是决定技术引进与创新能否成功的关键；②要分层次有重点地进行技术引进和创新；注意技术创新后的知识保护等问题。     

创新是军队医院实现跨越式提升的必由之路

为探讨新形势下，军队医院实现跨越式发展，本阐述了新形势下军队医院必须改革创新；选择战略目标，确定改革创新点；针对绩效缺陷，实施全面创新；为更好地提高部队医疗保障能力提供参考。     

入世后人力资源开发在科技创新中面临的挑战

我国加入WTO后，我们必须对竞争形势进行认真地分析，及时制订有效措施，实施人力资源开发，使之在科技创新中发挥作用；使军队科技战线人员在全球化的竞争之中立球败之地。     

转轨时期医院经营管理效益量化评价方法研究

效益评价是医院经营管理中的一项重要工作。医院经营管理的效益分为社会效益和经济效益。两个效益的人为脱节和社会效益指标的虚化,形成了效益评价的难点。本文采取层次分析法,将医院的社会效益、经济效益与医院的投入、消耗和产出的１９个指标有机结合起来,使两个效益在有机统一的前提下指标量化,这样既增强了两个效益评价工作的可操作性,也增强了效益评价结果对医院经济工作指导的操作性。     

An economic evaluation of occupational health

There is an increasing need to evaluate the costs and benefits of an occupational health service (OHS). However, measuring benefits from an OHS is inherently difficult. Instead, an economic model can be constructed to present the minimum threshold benefits required for OHSs to be cost-effective, given what is known about costs. This model assumes that the benefits of an OHS are to maximize health and morale of employees; maximize performance and increase productivity; minimize medico-legal costs; enhance workplace safety; and reduce sickness absence. A certain distribution across these benefits can be assumed for each OHS. The overall required value of all benefits brought about by use of an OHS is in the range 158-199 Pounds per year. The plausibility of results can be assessed using known data and judgement. Despite many uncertainties it is likely that the minimum benefit thresholds will be achieved overall.     

Employer-sponsored health insurance: pressing problems, incremental changes

Despite large premium increases, employers made only modest changes to health benefits in the past two years. By increasing copayments and deductibles and changing their pharmacy benefits, employers shifted costs to those who use services. Employers recognize these changes as short-term fixes, but most have not developed strategies for the future. Although interested in "defined-contribution" benefits, employers do not agree about what this entails and have no plans for moving to defined contributions in the near future. While dramatic changes in health benefits are unlikely in the short term, policymakers may want to watch for future erosions in health coverage.     

Improving food choices among Supplemental Nutrition Assistance Program recipients

We used a principal-agent framework to examine the feasibility of two proposed modifications to the Supplemental Nutrition Assistance Program with the goal of encouraging healthier food choices among program participants. Specifically, we analyzed two types of contract: a restricted contract and an incentive contract. The restricted contract did not allow the purchase of unhealthy foods with program benefits, but compensated participants by increasing total benefits. The incentive contract provided increased benefits that varied according to the percentage of healthy foods purchased with program benefits. The theoretical results revealed the mechanisms for the two alternative contracts, the conditions under which each would be effective, and the key empirical questions to be examined for future policy analysis.     

How Do Patients Value the Benefit of Minimally Invasive Surgery in Cancer Treatment?

ObjectivesDue to the increasing cost of cancer treatment, the demand for value-based healthcare is increasing. Although several value frameworks have been developed recently in the field of oncology, the nononcological benefits of minimally invasive surgery have not been addressed. This study aimed to estimate how patients value nononcological benefits in minimally invasive cancer surgery.MethodsThe value that patients placed on various benefits of cancer surgery was termed throughout the study as patient value (PV). To quantize PVs for the benefits of cancer surgery, a one-tiered analytic hierarchy process model was constructed. The model includes 6 well-known surgical outcomes, including nononcological benefits. The study participants included 303 patients with cancer and family caregivers who participated in a questionnaire survey.ResultsThe PVs for “decreased operation time,” “reduced length of hospital stay,” and “improved cosmetic results” were 0.050, 0.044, and 0.045, respectively, whereas the PVs for “increased survival,” “prevention of disease recurrence,” and “avoidance of complications” were 0.366, 0.292, and 0.203, respectively. The PV placed on nononcological benefits from minimally invasive surgery was one-tenth (10.2%) of the total value.ConclusionsNononcological benefits arising from minimally invasive surgery were relatively small but nonnegligible. This value should be considered in the process of developing a value framework for cancer surgery and shared decision making.     

Initiation of prenatal care by low-income Hispanic women in Houston.

OBJECTIVE: To understand why many Hispanic women begin prenatal care in the later stages of pregnancy. METHODS: The authors compared the demographic profile, insurance status, and health beliefs--including the perceived benefits of and barriers to initiating prenatal care--of low-income Hispanic women who initiated prenatal care at different times during pregnancy or received no prenatal care. RESULTS: A perception of many barriers to care was associated with later initiation of care and non-use of care. Perceiving more benefits of care for the baby was associated with earlier initiation of care, as was having an eligibility card for hospital district services. Several barriers to care were mentioned by women on open-ended questioning, including long waiting times, embarrassment the physical examination, and lack of transportation. CONCLUSIONS: Recommendations for practice included decreasing the number of visits for women at low risk for poor pregnancy outcomes while increasing the time spent with the provider at each visit, decreasing the number of vaginal examinations for low risk women, increasing the use of midwives, training lay workers to do risk assessment, emphasizing specific messages about benefits to the baby, and increasing general health motivation to seek preventive care through community interventions.     

The costs and benefits to participants in community partnerships: a paradox?

This article examines the degree of stakeholder participation in health and social partnership schemes in relation to their perceptions of benefits, costs, satisfaction, commitment, and ownership. The findings suggest that (a) involvement, commitment, and sense of ownership were invariably associated with high benefits and mostly with low costs; (b) benefits, commitment, and ownership might be more sensitive monitors of involvement than costs and satisfaction; (c) an increase in involvement was initially associated with decreased costs and increased satisfaction up to a point beyond which costs increased and satisfaction decreased despite increasing benefits; and (d) favorable cost-benefit ratios were perceived when the benefits were at least 1.6 times the costs. Partnership initiatives need to explore the involvement "cut-off" point at which the costs (and satisfaction) might change direction. For favorable cost-benefit ratios, benefits need to be at least 60% more than costs (Ansari's paradox).     

Addressing the Silence in the Noise: How Abortion Support Talklines Meet Some Women's Needs for Non-Political Discussion of Their Experiences

Little progress has been made toward increasing physical activity in women. This study aimed to determine if an 8-month theory-based book club intervention (Women Bound to Be Active) was effective in increasing: (a) self-worth, (b) benefits relative to barriers to physical activity, and (c) physical activity in women (n = 51). Findings suggested a book club was effective for improving: self-worth, the benefits relative to barriers to physical activity, and possibly participation in physical activity. This is an innovative model to help women become more active and learn skills that may enable them to be active on their own long after a physical activity program has ended.     

Can electronic medical record systems transform health care? Potential health benefits, savings, and costs

To broadly examine the potential health and financial benefits of health information technology (HIT), this paper compares health care with the use of IT in other industries. It estimates potential savings and costs of widespread adoption of electronic medical record (EMR) systems, models important health and safety benefits, and concludes that effective EMR implementation and networking could eventually save more than $81 billion annually--by improving health care efficiency and safety--and that HIT-enabled prevention and management of chronic disease could eventually double those savings while increasing health and other social benefits. However, this is unlikely to be realized without related changes to the health care system.     

Termination of health benefits for Pittston mine workers: impact on the health and security of miners and their families

Mine workers represented by the United Mine Workers of America (UMWA) have had comprehensive medical care coverage since 1950. On February 1, 1988, UMWA employees of the Pittston Coal Group had their health care benefits abruptly terminated. Renewal of these benefits became a major reason for the subsequent UMWA strike against Pittston. In December, 1989, physician interviewers were organized to document the human experience of this termination of health care benefits. This report summarizes these interviews, and concludes that the UMWA experience in the Pittston coal fields is one example of the barriers to health care experienced by an increasing proportion of the United States population.