医院评审对护理管理改革的促进作用

新一轮医院评审强调落实“以病人为中心”的责任制整体护理工作模式,注重安全、优质护理的效果,特别是病人的体验;强化医院系统管理对病人安全或不良事件的责任,弱化护士个人对病人安全或护理安全（不良）事件的责任,促进医院注重多部门的协作与联动机制的形成;评审方法采用个案追踪和系统追踪法更是客观真实地评价医院的日常工作,从而体现医疗安全与质量,督促医院建立安全与质量管理的长效管理机制。     

我院建立成本核算模式的体会与绩效评价体系探讨

文章论述了医院成本核算的内容,方法以及医院成本核算的主要步骤,探讨了建立医院绩效评价体系应考虑的因素.     

Current caesarean delivery rates and indications in a major public hospital in northern Greece

Background:   Over the past 25 years, there has been a sustained increase in caesarean section (CS) rates around the world. However, there is a paucity of data regarding the current CS rates and particularly the trends of CS indications in Greece.
Aim:   To assess the overall CS rates and indications in a major Greek teaching hospital over the last five years.
Methods:   All deliveries that took place in our Department between January of 2002 and December of 2006 were retrospectively analysed through manual medical chart review to record CS rates and indications.
Results:   During the study period, 4964 deliveries took place in our department; among them, 1831 were CS (36.9%). The overall caesarean delivery rate has remained stable during these five years (36.7% during 2002 vs 35.5% during 2006; P  = 0.633). The primary indications were previous caesarean delivery (30.9%), non-reassuring or pathological fetal heart rate trace by cardiotocography (12.3%) and dystocia (10.4%). The only indication whose rate significantly increased was previous caesarean delivery (+47.3%; P  = 0.002), whereas a significant decrease was found for non-reassuring or pathological fetal heart rate trace by cardiotocography (–39.1%; P  = 0.008).
Conclusions:   It is quite difficult to reduce the proportion of caesarean deliveries, particularly in a teaching hospital with a considerable number of high-risk pregnancies. The dominant role of previous caesarean delivery among CS indications stresses the importance of performing more vaginal birth after CS if we are to avoid the self-perpetuation of the CS epidemic.     

医院科研信息支持服务研究

本文分析了医院图书馆开展科研项目信息支持服务的需求及可行性,探讨了医院科研项目信息支持服务主要内容,期望找出一种更加合理的科研信息服务模式,以满足医院科研快速发展的需要.     

嵌入临床科研一线的学科化服务探索与实践

本文认为嵌人用户的临床科研环境是学科化服务的关键,阐述了学科化服务嵌人临床科研的背景及动因,分析了医院图书馆学科化服务存在的问题,探讨了嵌入临床科研一线学科化服务的具体措施。     

集团医院Enterprise-PACS构建思维

随着集团医院逐步成为一种新型有效的医疗健康服务模式以及区域化信息服务需求的增长,Enterprise-PACS正在成为新一代医学信息网络发展和应用的一支生力军。在我国,E-PACS的应用处于起步阶段。2005年5月我院集团医院E-PACS项目开始启动。在经历一年国外文献复习、大量现场调研以及结合我院实情的需求分析后,项目规划、设计及实施方案初步形成。今年底之前,该E-PACS项目将投入实施。本文就E-PACS背景、构建策略以及挑战进行讨论。     

军队医院等级评审中药事管理工作成果分析

目的分析济南军区总医院在等级评审中药事管理工作的做法、成效及建议,以供参考。方法重点介绍该 院在军队医院等级评审中,药事管理方面所进行的一系列工作,并分析等级评审前后基本药物及抗菌药物使用情况。结果 评审期间2012年1月-8月,基本药物品种比例及基本药物使用金额比例均明显提高,门诊患者抗菌药物处方比例由26.5% 下降到13. 7%,急诊患者抗菌药物处方比例由54. 5%下降到37. 82%,住院患者抗菌药物使用率由73. 03%下降到49. 60%, 住院患者抗P药物使用强度巳从80DDDs降至30.95DDDS。结论医院等级评审药事管理工作有效地促进了该院基本药物 及抗菌药物的合理应用。     

部队医院实习护生岗前培训实践

目的探讨部队医院实习护生岗前培训的方法和效果。方法对1 621名部队医院实习护生进行包括护理部负责制、专业组负责制、护理标兵负责制、院级教员负责制、相关部门负责制、学员队负责制体系的岗前培训;培训方式采取集中授课、多媒体教学、互动式示范教学、情景模拟、现场答疑、拓展训练等,以及多种考核方式。结果通过岗前培训实践,护生的理论知识、专业技能等10项成绩及教师对其的评价均显著提高(P<0.05,P<0.01)。结论构建部队医院特色的岗前培训体系有利于实习护生综合素质的培养。     

“关注美容疼痛,走向无痛医院”认知度调查研究

目的:调查研究社会公众对"关注美容疼痛,走向无痛医院"相关的认知程度。方法:设计与"关注美容疼痛,走向无痛医院"相关的问卷并进行随机抽样调查。由广州医科大学的在校本科生派发问卷进行调查。问卷形式为选择题。结果:共发放1400份问卷,回收的有效问卷1275份,回收率达91.07%。结果显示,54.15%的疼痛患者会选择忍耐而不去就医;31.37%的人认为技术治疗和心理呵护在"无痛医院"建设中同等重要;32.59%的人认为当今医院对"无痛医院"的理念虽有践行,但效果不明显;多数人认为限制无痛治疗进行的首要因素是现代科技条件;对患者就医过程中角色的重要性进行的调查结果显示:主管医师占据第一位。结论:社会大众普遍对"无痛医院"的了解程度都比较低,对于生活中的基础疼痛知识了解得较多,而对于医疗上的专业疼痛则认知少。同时,当今社会对"无痛医院"理念的践行情况不容乐观,绝大多数人认为其中最主要的限制因素是现代医疗科技条件。     

Total versus subtotal thyroidectomy for the management of benign multinodular goiter in an endemic region

BACKGROUND: Because controversy still continuous to surround use of total thyroidectomy for the management of benign multinodular goiter, the present study aims to prospectively compare the safety and efficacy of total thyroidectomy with subtotal thyroidectomy. METHODS: A total of 200 consecutive patients with benign multinodular goiter were assigned to have either total thyroidectomy (n = 105) or subtotal thyroidectomy (n = 95) based on preoperative evaluation, intraoperative macroscopic findings and nodular dissemination. The patients with no healthy tissue or nodules localized in the dorsal part of the gland, which are usually left during normal subtotal resection, were assigned to the total thyroidectomy group. Demographic details, biochemical findings, indications for operation, operating time, specimen weight, complications and hospital stay were noted. RESULTS: There was no significant difference in the sex, hormonal status or duration of goiter between the two groups (P = 0.74, P = 0.59 and P = 0.59, respectively). The mean operating time was longer (148.52 min +/- 51.10 vs 135.10 min +/- 32.47, P = 0.03), and the mean weight of the specimens was greater (228.40 g +/- 229.91 vs 157.01 g +/- 151.23, P = 0.01) for total rather than subtotal thyroidectomy. Either temporary recurrent laryngeal nerve (RLN) palsy or hypoparathyroidism occurred in 10 (9.3%) or 12 (11.4%) of the patients undergoing total compared with six (6.3%) or nine (9.5%) of the patients undergoing subtotal thyroidectomy (P = 0.40 and P = 0.65, respectively). Either permanent RLN palsy or hypoparathyroidism was observed in one patient undergoing total thyroidectomy (P = 0.34 for each comparison). The mean hospital stay was longer in the total thyroidectomy group (2.24 days +/- 1.18 vs 1.89 days +/- 0.72 for subtotal thyroidectomy, P = 0.01). CONCLUSIONS: The present study shows that total thyroidectomy can be performed without increasing risk of complication, and it is an acceptable alternative for benign multinodular goiter, especially in endemic regions, where patients present with a huge multinodular goiter.