医院科室预算编制方法的创新

通过对科室预算的编制形式、编制流程的探讨,明确科室预算的编制标准和操作细则。提出编制医院科室预算的具体方案,辅助医院年度经营计划的顺利实施,提高科室的工作绩效。     

初级卫生保健试点县妇幼保健投入产出分析

  目的  分析2000 — 2017年京沪妇女保健财力资源适宜程度及孕产妇死亡率的变化趋势,明确2地差异,探讨妇女保健财力资源适宜程度。  方法  收集1995 — 2017年涉及京沪妇女保健财力投入政府主导问题（202篇）、投入总量问题（205篇）和投入增长问题（122篇）文献,综合投入政府主导适宜程度、投入总量适宜程度、增长适宜程度等3个指标,计算财力资源的适宜程度。运用Spearman相关、线性回归等分析妇女保健财力资源适宜程度与孕产妇死亡率的关系。  结果  北京妇女保健财力资源适宜程度从2000年的28.40 %升至2017年的42.60 %,上海则由22.60 %升至69.40 %,北京和上海的回归方程均有统计学意义（上海P < 0.01,北京P < 0.05）。  结论  京沪2地妇女保健财力资源适宜程度逐年提高,上海财力资源在孕产妇死亡率下降中作用更大,但财力投入稳定增长仍是薄弱环节;适宜的妇女保健体系应“政府负责、投入适宜、稳定增长”;验证了量化妇女保健财力资源适宜程度的可行性。     

基于心脏磁共振组织追踪初步探究左心房功能预测缺血性心脏病患者预后的价值

目的:初步探究左心房功能预测缺血性心脏病患者出现主要不良心血管事件(MACEs)的价值。方法:回顾性搜集2018年10月-2020年7月共30名确诊缺血性心脏病患者,在二腔心、四腔心层面分别勾画左心房储存期、导管期以及泵血期的心内膜、心外膜轮廓,得到各期左心房容积,采用心脏磁共振组织追踪技术自动生成左心房应变-时间曲线以及应变率-时间曲线并得到左心房三期射血分数、应变以及应变率。采用受试者操作特征(ROC)曲线计算左心房功能参数对于缺血性心脏病患者出现MACEs的预测价值。采用Bland-Altman图评价两位有心脏磁共振诊断经验的医生测量左心房功能参数的一致性。结果:MACEs组左心房储存期射血分数[(37.85±13.86)%vs.(48.40±10.95)%,P=0.028]、应变[13.40(7.25,15.80)%vs. 19.20(13.38,24.68)%,P=0.011],导管期应变[4.6(2.65,7.38)%vs. 9.2(6.5,11.20)%,P=0.003]以及泵血期应变率[-0.65(-1.3,-0.5)/s vs.-1.55(-1.83,-1.00)/s...     

电阻应变式传感器在下肢牵引手术中的应用

目的 研究电阻应变式传感器（RSS）在不同下肢骨折类型手术中的应用。方法 选择2020年10月—2022年8月中国科学技术大学附属第一医院收治的外伤性下肢骨折患者99例,按照骨折类型分为股骨粗隆间骨折组79例、股骨干骨折组15例、股骨颈骨折组5例。患者均在牵引床上行闭合复位内固定术,使用RSS测量3组不同骨折类型手术中的初始牵引力、牵引时长、松解牵引力。记录手术时间、术中出血量,术后评分及3组不同骨折类型手术前后血色素变化及输血情况;比较使用不同内固定方式（长髓内钉、短髓内钉、空心钉）的术中牵引力和手术出血量、手术时间;比较长髓内钉固定患者和短髓内钉固定患者时下肢旋转角度。结果 3组不同骨折类型初始牵引力、牵引时长、松解牵引力、手术时长、术中出血量、术后评分比较,差异均有统计学意义（P <0.05）。3组不同骨折类型术前、术后血红蛋白、红细胞压积比较,差异均有统计学意义（P <0.05）。3组术中输血情况比较,差异有统计学意义（P <0.05）,术后输血情况比较,差异无统计学意义（P>0.05）。使用不同内固定方式的患者牵引总时长、年龄、术中出血量、手术时间比较...     

医药分开对公立医院职工收入的影响分析

目的:分析医药分开对我国公立医院收入结构和职工收入产生的影响,并指出主要影响因素及应对措施.方法:采用数据对比分析法和预测分析法,分析医药分开改革的正反两方面影响因素及影响程度.结果:医药分开直接切断了医院收入与药品销售之间的利益关系,减少医院收入的同时也对医院职工收入分配结构产生巨大冲击.结论:在医务人员价值定位仍处较低水平时,医药分开迫使医院思考如何有效落实绩效工资制度、如何对收入分配要素进行调整、如何使薪酬级差体现专业技术水平差异.     

Effects and Clinical Significance of GII.4 Sydney Norovirus,United States, 2012–2013

During 2012, global detection of a new norovirus (NoV) strain, GII.4 Sydney, raised concerns about its potential effect in the United States. We analyzed data from NoV outbreaks in 5 states and emergency department visits for gastrointestinal illness in 1 state during the 2012–13 season and compared the data with those of previous seasons. During August 2012–April 2013, a total of 637 NoV outbreaks were reported compared with 536 and 432 in 2011–2012 and 2010–2011 during the same period. The proportion of outbreaks attributed to GII.4 Sydney increased from 8% in September 2012 to 82% in March 2013. The increase in emergency department visits for gastrointestinal illness during the 2012–13 season was similar to that of previous seasons. GII.4 Sydney has become the predominant US NoV outbreak strain during the 2012–13 season, but its emergence did not cause outbreak activity to substantially increase from that of previous seasons.     

Response to Ozone in Volunteers with Chronic Obstructive Pulmonary Disease

Twenty-eight volunteers with chronic obstructive pulmonary disease were exposed to 0.0, 0.18, and 0.25 ppm ozone in purified air for 1-hr periods with light intermittent exercise, with exposure conditions presented in random order at 1-month intervals. No statistically significant changes attributable to ozone were found in forced expiratory performance or percent oxyhemoglobin (measured near the beginning and end of each exposure). No ozone-related changes in clinical status were found by interviews that included the time for 1 wk before to 1 wk after each exposure, except that a moderate increase in lower respiratory symptoms was reported by nonsmokers in 0.18 ppm exposures only. Thus, a slight decrement in hemoglobin saturation with ozone exposure (reported in two previous studies of chronic obstructive pulmonary disease subjects) may not be a common occurrence under typical ambient exposure conditions.     

NOTES ON THE SUPPRESSON OF BUSHFIRES FROM AIRCRAFT

The paper presents a review of pole utilization in Australia. Commercial pressure treatment of poles commenced in 1987.

The service life of poles based on their natural durability is discussed, together with a brief consideration of the advantages of wooden poles compared with those of other materials. Attention is drawn to the change in specifications resulting from the rising demand for pole timber suitable for preservation, and to the importance of knots in Pinus species, in relation to impregnation and strength.

An outline is given of present pole preservation treatment in Australia and current problems are briefly discussed—splitting of certain species, slow drying and the possibility of developing artificial seasoning, low retention of preservatives and variations in absorption between poles in a charge in hardwoods and fungal attack, strength, and knots in softwoods.

The paper is designed to provide Australian foresters with an outline cf aspects of pole utilization which require to be taken into consideration for forest management.     

NEW SOIL CONSERVATION ACT IN VICTORIA

The breeding programme at Traralgon aims to improve Eucalyptus regnans F. v. M. as a forest tree by increasing the rate of growth, improving wood quality, and increasing resistance to damage by fire. Improvement may be accomplished in three ways:—(1) provenance trials (to determine the best place to collect seed for afforestation in a given location), (2) selection of individual trees within the chosen provenance, and (3) hybrids with species with greater resistance to fire and the ability to grow on poor sites. The major part of the work has been the provenance trials which show continuous genetic variation with altitude on the south eastern side of Mount Erica, Victoria.

Seed for the trials was collected in October 1959 from 68 trees on Mount Erica. with an average of 10 trees at each of seven altitudes from 1200 feet to 3250 feet. Studies were made of capsule size, germination, cotyledon area, and growth of seedlings in the nursery. Sixty-four open pollinated progenies were planted in a cubic lattice design in the Strzelecki Ranges at 1650 feet, and some smaller trials were planted at other places. Field measurements at two years of age and again at three years confirmed the trend shown in the nursery that seedlings from higher altitudes grew more slowly. Leaf shape also varied with altitude but survival of seedlings did not. A study of the relation of nursery measurements to field measurements showed promise of a technique for culling the slowest growing progenies in the nursery without the need for field planting all the progenies.

An examination of growth rates of progenies from a given altitude showed that large dominant trees rarely produced the fastest growing seedlings, consequently trees selected for breeding should not be simply the largest individuals but rather the parents which give the best progeny in nursery and field trials.

Experiments were commenced on the value for forestry of hybrids of E. regnans and some observations were made on seed production.     

Pay for Performance Improves Rural EMS Quality: Investment in Prehospital Care

Objective. To evaluate the effect of a system of financial reward for emergency medical technicians (EMTs) who meet selected quality marker goals. Methods. This project was reviewed by an institutional review board (IRB) andwas found to be exempt from IRB review. Two operational andfour clinical markers were targeted for improvement. Baseline performance measurements were retrospectively measured for the preceding year, andchallenging but achievable goals for improvement were established. Operational markers included completing run reports within three hours after completion of the run andcall-to-en route (“out-of-chute”) times of less than 90 seconds for emergency calls on our first-line ambulance. Clinical markers included the use of aspirin in adults with nontraumatic chest pain, electrocardiogram (ECG) performance in adults with nontraumatic chest pain, documentation of pain assessment andintervention in patients with traumatic hip pain, anddocumentation of the time of onset of symptoms in stroke calls. Each full-time EMT could earn up to $1,000 in addition to baseline pay, with part-time EMTs eligible for prorated amounts. Results. Postincentive run reports were completed within three hours 99.7% of the time, with 21 of 24 providers meeting the goal 100% of the time. Before the incentive, reports were completed within three hours 64% of the time, with only two of 23 providers meeting the goal 100% of the time. The out-of-chute goal of less than 90 seconds was met 98.7% of the time, compared with 90.1% before the incentive. Aspirin use in adult nontraumatic chest pain improved from 68% to 96.3%, andECG performance in this group improved from 43% to 87.8%. Documentation of the time of onset of symptoms in stroke patients improved from 97% to 100%, andthe assessment of andintervention for pain in traumatic hip pain patients improved from 56% to 100%. Conclusion. Financial motivation improved targeted quality measures in this rural emergency medical service. It appears to be a useful adjuvant to traditional quality improvement mechanisms.