质量控制在GLP中的实践与体会

药物非临床研究质量管理规范（Good Laboratory Practice,GLP）是药物非临床实验的质量管理指南,是人类用药安全的最后屏障。质量控制室以实验工作为导向,以专业分工为原则,建立可控、有效、独立的质量控制方法,使实验工作在可控的环境中进行,有效地保证了GLP实验的开展,提高了工作效率。     

卫生高级职称量化评审方法的研究与应用

为了建立品德、能力、业绩全面考察的专业化、量化、两级职称评审方法,经过广泛调研、反复讨论和测试、细化量化指标和权重,建立了公示评审标准、严格评审程序、建立监督机制、公示评审结果等符合医院发展需求的高级职称量化评审方法。本方法应用4年来,避免了以往高级职称评审中遇到的诸多积弊,较真实地考察了专业技术人员的技术能力与业绩,弱化了医院等级、地域分布不同等带来的职称评审的难点问题。量化评审方法体现了公平、公正、公开,为专业技术人员的职业生涯发展指明了努力的方向,得到了相关部门和专业技术人员的广泛认同。     

Specialization and competition in healthcare delivery networks

Hospital networks, which offer multiple services at multiple locations, are investigating strategies to fight the growing competition from specialty hospitals. Specialty hospitals focus on a selective range of profitable services, have better control over costs, and deliver higher (perceived) quality. A hospital network too can create specialized facilities; however, this may lead to the loss of sales from services that it no longer offers. Using a spatial model, we study when it is profitable for the network to specialize, and how to determine which facilities provide the greatest value through specialization. We find that a hospital network, when facing specialized competitors, can often improve its overall profitability by specializing some of its facilities; and that among its different facilities, the network’s best choice for specialization is the facility that is closest to the competitor, and thus most directly affected. Interestingly, we find that the value of specialization is contingent upon the competitive pressure that the specialized competitor exerts on the network. Specializing one facility yields the greatest benefits for the network when the competitor is located at the fringe of the market, thus presenting a reduced threat to the hospital network. On the other hand, if the specialized competitor is located at the core of the network’s customer base, we find that the attractiveness of specializing one facility is much smaller and that the hospital network might fare better with a strategy based on diversification, i.e., offering a full-menu of services at every facility.

Physiotherapists in occupational health — the Australian experience

Abstract

Occupational health physiotherapy (OHP) as a distinct discipline has been practised in Australia since the 1970s. In 1984, a national special interest group was formed within the Australian Physiotherapy Association (APA) to provide professional support and education for the growing numbers of physiotherapists in the field. In its latest form the group has nearly 300 members with chapters in each of the six states and in one of two territories. Since 1999, the APA has facilitated the development of a structured tiered career pathway for its members in all the special interest groups. To date, a number of OHP members have successfully completed the recognition process for advanced standing in the field of OHP and become either Titled or Specialist. It is planned to increase the numbers of physiotherapists working at advanced practitioner levels in workplace health and safety and continue to have OHP representatives on peak national health and safety groups and key bodies in the workers' rehabilitation and compensation field. The way forward for the special interest group lies in furthering educational opportunities for group members, and improving knowledge of other stakeholders including the physiotherapy profession about the skills group members have. Opportunities for networking and sharing resources via an international subgroup may be a reality in the near future.     

Medicina interna en el Uruguay. Enseñanza de la especialidad

Internal medicine in Uruguay has undergone a change in recent years related to labor and economic aspects at our society level. This is rethought to the formation of the speciality trying to achieve a doctor more competent and updates with a profile in line with the progress of medicine worldwide. This is a review of the teaching of the speciality in internal medicine in Uruguay with the most innovative aspects in term of training.     

药品监管公务员专业化的含义及其能力要求初探

建设高素质、专业化的药品监管公务员队伍是药品监督管理基础性、战略性的任务。我国药品监管公务员队伍组建的时间不长,队伍的专业分布、学历层次与知识结构都与药品监管职能的要求存在着一定差距。针对这一问题,在大量调研的基础上,对药品监管公务员专业化的概念、含义以及其能力要求进行深入探讨。     

The value of specialization--is there an outcome difference in the management of fistulas complicating diverticulitis

PURPOSE: The value of specialization has frequently been challenged by many health care institutions and providers. This review was conducted to determine whether there were any outcome differences in the management of fistulas complicating diverticulitis. METHODS: We conducted an historical cohort study using hospital charts of all cases of fistulas complicating diverticulitis that were operated on in four university-affiliated hospitals between 1975 and 1995. There were 122 patients, with 37 under the care of fully trained colorectal surgeons and 85 under the care of general surgeons. RESULTS: There were no significant differences in patient demographics, preoperative comorbidities, or the number of preoperative diagnostic investigations between the two groups. The colorectal surgeons performed more intraoperative ureteral stenting (Colorectal Surgery 55.5 percentvs. General Surgery 24.4 percent,P=0.001). The general surgeons performed more initial diverting Hartmann's and colostomy procedures (Colorectal Surgery 5.4 percentvs. General Surgery 27 percent,P=0.013). The patients in the General Surgery group had longer preoperative lengths of stay (median Colorectal Surgery 3 (range, 1–28) daysvs. General Surgery 8 (range, 0–29) days;P<0.001), longer postoperative lengths of stay (median Colorectal Surgery 11 (range, 5–40) daysvs. General Surgery 14 (range, 2–80) days;P=0.001), and longer total lengths of stay (median Colorectal Surgery 14 (range, 6–62) daysvs. General Surgery 24 (range, 6–100) days;P<0.001). The patients in the General Surgery group experienced a higher rate of wound infections (Colorectal Surgery 5.4 percentvs. General Surgery 12.9 percent), and a larger proportion of them experienced complications (Colorectal Surgery 27 percentvs. General Surgery 41.2 percent). CONCLUSIONS: We conclude that specialization in colon and rectal surgery contributed to an improved outcome, with a lower rate of diverting procedures, a shorter hospital stay, and a lower rate of complications.Presented at the meeting of The American Society of Colon and Rectal Surgeons, Boston, Massachusetts, June 24 to 29, 2000.