2009-2011年上海医院心血管系统疾病用药分析

目的：了解近年来上海医院心血管系统疾病用药的情况和变化趋势。方法：统计2009—2011年上海119家样本医院心血管系统疾病用药销售金额、排序和增长率等,结合临床应用进行分析和讨论。结果：心血管系统疾病用药金额仅次于抗感染类药物,列为第2大类,复合年均增长率11．81％。用药金额领先品种有银杏叶制剂、氨氯地平、缬沙坦、发酵虫草制剂等,增速较快的有银杏叶制剂、丹参多酚酸盐、替米沙坦、厄贝沙坦和灯盏花素等。结论：心血管系统用药是一大类常用药物,需求量逐渐增大,市场前景广阔。     

In-hospital mortality among rural Medicare patients with acute myocardial infarction: the influence of demographics, transfer, and health factors

Context/Purpose: Most rural hospitals can provide medical care to acute myocardial infarction (AMI) patients, but a need for advanced cardiac care requires timely transfer to a tertiary hospital. There is little information on AMI in‐hospital mortality predictors among rural transfer patients. Methods: Cross‐sectional retrospective analyses on 2003‐2005 Medicare hospital inpatient data from 5 states were conducted to compare predictors of in‐hospital AMI mortality between rural hospital transferred and nontransferred patients. A total of 9,690 rural hospital AMI patients were identified: 3,087 were transferred to receiving hospitals and 6,603 were not transferred. Separate logistic regressions were conducted for transferred and nontransferred patient cohorts and results were compared. Results: Transfer patients were younger, more likely male, had fewer comorbidities/complications, and were less likely to expire (5.3% vs 16.7%) in the hospital. Congestive heart failure and cardiac dysrhythmia were the most common comorbidities/complications among transfer and no‐transfer AMI patients, but shock (OR = 9.44) and acute renal failure (OR = 3.67) had the strongest associations with in‐hospital mortality for both cohorts. Undergoing a percutaneous coronary intervention (PCI) was associated with a 42% reduction in hospital mortality risk for transfer patients. Conclusions: Transfer was associated with a greater likelihood of in‐hospital AMI survival, largely but not fully explained by transfer patients being younger with fewer comorbidities/complications who are receiving advanced cardiac care. Additional studies are needed to clarify other factors that explain higher in‐hospital mortality among nontransfers, such as patients’ health care decision‐making.     

学习管理评价指南加快医院建设与发展

为指导各级卫生行政部门加强对医院的管理，科学、客观、准确地评价医院，配合医院管理年活动，促进医院加强内涵建设，不断提高医院管理水平，卫生部新出台了《医院管理评价指南（试行）》（以下简称《指南》）。作者回顾了我国开展医院评审的实施过程和《指南》出台的有关历史背景，介绍了《指南》的指导思想、主要目标、制定原则、核心内容和主要特点，最后对《指南》中强调的关键问题和重要考核内容进行了讲解和分析。作者简述了学习体会，以供大家讨论和参考。     

新形势下公立医院收费人员激励问题思考

通过对激励理论及有关医院激励的文献研究,对新形势下公立医院收费人员激励问题提出几点思考。     

公立医院行政管理人员的现状与思 考简

科学有效的管理可以给医院带来倍增的潜在利益,只有建立起完善的科学管理制度,才能够有效提升医院综合品质,这也使得医院的行政管理地位愈发重要。本文基于医院院长办公室、人事部门等行政工作人员的视角,从阐述行政管理人员现状人手,通过对行政管理人员现状中存在的若干问题与根源分析,提出相应对策与解决途径,在建立合理的人事考核制度机制的基础上,搭建比较高效的行政管理平台,从而促进实现现代化公立医院的可持续发展的日标。     

Placing care: embodying architecture in hospital clinics for immigrant and refugee patients

This article is part of a hospital ethnography that investigates healthcare architecture as an aspect of an increasingly large, complex, and urgent global health issue: caring for refugees and other immigrants. It argues that hospitals are nodes in transnational social networks of immigrant and refugee patients that form assemblages of human and non‐human objects. These assemblages co‐produce place‐specific hospital care in different hospital spaces. Place‐specific tensions and power dynamics arise when refugees and immigrants come into contact with these biomedical spaces. The argument is developed by analysing waiting rooms and exam rooms in two outpatient clinics in one US hospital. The article draws its analysis from 9 months of fieldwork in 2012 that included following 69 adult immigrant and refugee patients and observing their encounters with interpreters and clinic staff. Its inclusion of a transnational dimension for understanding place‐specific hospital care adds conceptual and empirical depth to the study of how place matters in 21st century hospitals.     

新型冠状病毒肺炎疫情期间武汉方舱医院的供应药品分析

目的分析新型冠状病毒肺炎疫情期间武汉方舱医院供应药品的品种,为方舱医院药物遴选及合理用药提供参考。方法以武汉市东西湖方舱医院为样本医院,系统分析该样本医院的药品目录,对比方舱医院实际供应药品目录与推荐目录的差异,分析药品的剂型和给药途径。结果样本方舱医院共供应114种药品,有35种药品是超出推荐目录范围内的药品;现有药品中,药品剂型以注射液(41种,占35.96%)和片剂(33种,占28.95%)为主,给药方式以口服(54种,占47.37%)和注射(51种,占44.74%)为主,药物剂型和给药途径均较集中。结论方舱医院的药学服务应注重口服给药的药物相互作用和注射给药的配伍禁忌,临床使用时应加强监护。     

企业医院产权制度改革探索

在分析企业医院现状和存在问题的基础上,介绍了企业医院产权制度改革的做法.对企业医院建立现代医院制度,提高效益和效率,推行区域卫生规划,加快产权制度改革步伐,促进企业医院发展进行了思考.     

农村乡镇卫生院突发公共卫生事件危机管理脆弱性评价指标体系的构建

目的 构建一套科学合理的农村乡镇卫生院突发公共卫生事件危机管理的脆弱性评价指标体系并对其进行检验。方法 通过文献研究,构建指标框架,采用专家咨询法建立评价指标体系,并进行信效度检验。结果 两轮专家咨询参与程度分别为80.0%和92.0%,权威程度分别为0.600和0.652,协调系数分别为0.160和0.442(〖XC小五号.EPS;P〗=573.096,P<0.01),差异具有统计学意义。指标体系包括4个一级指标,9个二级指标,33个三级指标。4个一级指标的权重分别为0.217 2,0.274 2,0.298 5和0.212 7。结论 该指标框架的可靠性和可信性程度较高,能够为测量农村基层乡镇卫生院突发公共卫生事件危机管理的脆弱性提供依据。     

基于杜邦模型的非营利性医院财务状况宏观分析

目的通过对我国非营利性医院财务状况的分析,评估非营利性医院资金运营状况。方法 运用经典财务分析系统——杜邦模型对全国非营利性医院2002-2007年财务年度指标进行计算和分析。结果非营利性医院固定资产快速增加．业务收支结余为负．净资产收益率大都为负值,医院基本处于亏损经营状态。结论现阶段非营利性医院成本快速上升是造成亏损的主要原因,医院仍然处于“粗放”式经营阶段。