基于层次分析法的公立医院公益性评价指标体系构建

目的用层次分析(AHP)法对公立医院公益性评价各指标量化,以期为建立科学合理的评价指标体系提供一个有效的方式借鉴。方法根据德尔菲法调查结果,用AHP软件建立层次模型,构造判断矩阵,计算各指标权重。结果确定了含3个一级指标,7个二级指标和26个三级指标在内的公立医院公益性评价指标体系,指标涉及医疗服务质量,社会评价等方面。其中医疗服务质量体系评价的权重系数为0.637,明显高于权重系数为0.105的医疗服务的社会评价。结论在对所建指标体系进行一致性检验后,证明了AHP法的科学性和可行性。但是指标体系中仍存在弊端,还需逐步修改。     

突发化学中毒事故紧急医疗救援应重视的问题

突发化学中毒事故是突发公共卫生事件常见的表现形式之一,也是紧急医疗救援的主要任务之一。化学中毒事故应急救援体系整体建设,化学中毒紧急医疗救援预案的制定,紧急医疗救援队伍的建设、培养,技术和后勤保障工作,医护人员现场救援时的安全防护,现场急救措施的合理性是突发化学中毒事故紧急医疗救援应重视的问题．是救援行动能迅速、准确、高效进行的保证。     

托管模式下公立医院的发展变化与分析

介绍三级医院托管二级医院的经营模式,并对医院托管后在科室设置、医疗业务、科研开展、人才培养等方面的变化进行分析。表明公立医院通过托管经营,可促进医院的良性发展,并能在一定程度上缓解群众看病难、看病不放心、看病不方便等问题,但应注意医疗费用的控制。     

护理本科生临床实践教学质量控制的实践

目的探讨护理本科生临床实践教学质量监控体系在临床实践教学中的应用与效果。方法将护理专业本科2007级四年级学生48名设为对照组,护理专业本科2008级四年级学生62名作为试验组。试验组采用临床实践教学质量监控体系,即用控制论的思想与方法进行教学管理,对照组采用传统的临床教学质量管理方法。结果试验组学生在出科考核成绩、护理文件书写质量、临床护理综合能力测试、带教教师对学生的满意度等方面好于对照组（P〈0.01或P〈0.05）。结论护理本科生临床实践教学质量控制体系有利于提高学生的临床实践能力,值得推广应用。     

以三维绩效结构理论构建军队医院护士长绩效考核指标体系

目的 建立一套科学、客观、全面的军队医院护士长绩效考核指标体系.方法 以三维绩效结构理论为基础,应用质性研究法、专家小组讨论及德尔菲(Delphi)专家咨询法,定量分析各指标的权重,建立军队医院护士长绩效考核指标体系.结果 建立了医院病区护士长绩效考核指标体系,包含任务绩效、关系绩效、适应性绩效3部分内容的Ⅰ级指标3条、Ⅱ级指标10条、Ⅲ级指标68个条目池.结论 以三维绩效结构理论构建的军队医院护士长考核指标体系,为全面实施有效、充分量化、真实地评估病区护士长的绩效管理提供依据.     

Use of physical restraints in acute hospitals in Germany: A multi-centre cross-sectional study

Background

Physical restraints are contrary to patients’ autonomy and freedom. Their justification for controlling psychomotor agitation and risk of falling is being questioned more and more often. Physical restraints are associated with many negative outcomes.The German law is explicit, allowing physical restraints in nursing only as an exception. Data on the use of physical restraints in acute hospitals in Germany are sparse.

Objectives

To investigate the prevalence of physical restraints and characteristics associated with physical restraint use in acute hospitals.

Design

Cross-sectional study.

Participants and setting

1276 patients (mean age 65 years, 45% women, 50% surgical) on 61 wards (n = 47 general; n = 14 intensive care) in four acute care hospitals in North Rhine-Westphalia, Germany.

Methods

One investigator visited each hospital ward at three randomly allocated time slots on randomly selected days within a period of three months. A total of 3434 direct observations on physical restraint status were collected. The study period lasted from October 2008 to March 2009. For analysis, one time slot per patient room was randomly chosen in order to avoid repeated analysis of the same patient.

Results

The prevalence of patients with at least one physical restraint was 11.8% (95%CI 7.8–15.7). The measures used most often were full bed rails (9.8%, 95%CI 6.5–13.1). There was pronounced prevalence variation throughout the wards (general wards: 0.0–31.3%; intensive care: 0.0–90.0%). The prevalence of physical restraints between hospitals ranged from 6.2 to 16.6%, the overall association with hospital was non-significant. Multivariate regression analysis revealed statistically significant characteristics for physical restraint use: age 80–99 years versus 18–54 years (adjusted odds ratio 4.34, 95%CI 2.18–8.64), feeding tube (2.70, 1.40–5.22), indwelling urinary catheter (6.52, 3.75–11.34), and staying in intensive care unit (3.39, 1.29–8.92). Sharing a multi-bed room (0.55, 0.35–0.89) and in situ central venous line were inversely associated (0.44, 0.19–0.98).

Conclusions

Physical restraints are apparently standard care in German acute hospitals. However, variation between wards indicates that hospital care with only few physical restraints is feasible. Respecting patients’ dignity and integrity warrants intervention programmes aimed at decreasing practice variation towards a general reduction of physical restraints in acute hospitals in Germany.     

客观结构化护理迷你临床评估演练培训在急诊临床教学中的应用

目的探讨在急诊科临床教学中应用客观结构化护理迷你临床评估演练对护理学专业学生进行培训的方法及效果。方法将60名在急诊科实习的护理学专业学生随机分为两组,两组均按照实习大纲进行日常教学,试验组在此基础上,每周应用客观结构化护理迷你临床评估演练进行1次培训．对照组每周考核一次护理理论及一项操作。培训结束后以客观结构化护理迷你临床评估演练对学生进行考核。结果试验组在临床接诊、人文医学、临床操作、健康咨询、组织效果和整体评价6项能力评分高于培训前（P〈O．01）,并且优于对照组（P〈O．01）,而体格检查和临床诊断2项能力评分培训前后比较和组间比较,差异无统计学意义（P〉0．05）。结论客观结构化护理迷你临床评估演练能有效提高学生部分护理实践能力,可以尝试在临床教学中进一步应用。     

Toxicologists in public health – Following the path of Louis Roche (based on the Louis Roche lecture “An accidental toxicologist in public health”, Bordeaux, 2010)

Background.?The global burden of clinical toxicology suggests a natural partnership with public health. This article reflects the content of a Louis Roche lecture given in 2010.

Historical context.?Our practice and research in clinical toxicology has evolved from clinical cases to toxico-epidemiology to public health. This evolution in practice was initially unplanned but gained momentum and impact as we placed it more formally in a public health framework. This perspective is implicit in Louis Roche's call to “examine all aspects of the poisoning problem” and still provides a valuable starting point for any clinical toxicologist.

Discussion.?Clinical toxicology has always had a patient centered focus but its greatest successes have been related to public health interventions. Our early failures and later success in pubic health toxicology correlated with our understanding of the importance of partnerships outside our field. The most rapid dissemination and implementation of information derived from research occur through apriori partnerships with other agencies and international partners.

Conclusion.?Addressing both local and global need has a number of bilateral synergies. Repositioning clinical toxicology into a public health framework increases access to strategic partnerships, research funds, and policy implementation while still addressing questions that are important to clinical practice.     

某公立医院皮肤科与某民营连锁皮肤病医院就诊患者疾病构成比较

目的了解某公立三级甲等医院皮肤科与某民营连锁皮肤病医院就诊患者疾病构成。方法获取2013年1—6月北京友谊医院皮肤科、北京京城皮肤病医院（医保定点民营专科皮肤病医院）及其连锁医院唐山京城皮肤病医院三家医院皮肤病门诊就诊数据,了解银屑病、白癜风、真菌感染性皮肤病及皮炎湿疹类皮肤病等门诊就诊人次构成,使用SPSS20．0及MicrosoftExcel对相关数据进行整理,使用卡方检验比较分析。结果三家医院皮肤病门诊构成及复诊情况存在显著差异。北京京城皮肤病医院银屑病及白癜风患者构成比及复诊率皆高于北京友谊医院皮肤科,而北京友谊医院皮肤科的真菌感染性皮肤病及皮炎湿疹类皮肤病构成比及复诊率较高。唐山京城皮肤病医院门诊就诊人次构成及复诊率与北京两家医院存在显著差异,其银屑病及白癜风患者构成比明显高于北京两家医院。结论三家医院皮肤病门诊各有特点,在某种程度上可以反映出公立医院与民营医院的差异,分析了解差异存在的原因,有助于优化医院资源配置,更好地为患者服务。