云南省弥渡县新型农村合作医疗补偿机制研究

目的 调查云南省弥渡县新型农村合作医疗运行2年来的补偿机制，了解补偿方案与具体补偿情况的关系，为新型农村合作医疗的推广提供借鉴。方法 收集县、乡两级合作医疗管理机构有关补偿情况的记录。并利用现有资料、通过个人访谈及集中小组访谈等方法了解试点的基本情况、补偿情况以及卫生服务情况等。结果 （1）实际补偿水平（29．32％）高于全国平均水平；（2）群众看病首选县级医疗机构。占全部参加合作医疗并就诊人群的60％以上；（3）补偿基金报销基本正常。结论 应鼓励群众参与，加大对乡镇卫生院的投入，引导村民到乡镇级医疗机构就医，以合理有效地利用卫生资源。     

新型农村合作医疗综合评价指标体系测评分析

目的 对新型农村合作医疗综合评价指标体系分析和验证。方法 采用相关和多元线性回归分析检验综合评价指标与内部指标问联系、信度分析和主成分因素分析，对综合评价指标体系进行评价。结果 新型农村合作医疗综合评价指标同内部指标具有正相关，内部指标具有独立性，总体指标克朗巴赫α系数为0．8889．指标体系内容效度极好。主成分分析表明指标体系具有较好的结构效度。结论 新型农村合作医疗综合评价指标体系的建立具有合理性、科学性和较好的信度与效度。     

新型农村合作医疗两级医疗机构门诊处方分析

目的了解云南省禄丰县乡、村两级医疗机构合作医疗实施后其处方用药的现状与存在问题，并提出促进合理用药的对策，进一步规范乡村医生用药行为。方法采用描述性统计分析方法和生物统计学分析方法。结果调查地区乡镇卫生院和村卫生室处方中，包含3～6种药品的比例分别为79．8％和76．9％，农村卫生室使用抗生素和激素的比例（分别为81％和32．5％）高于乡镇卫生院使用的比例（分别为77．3％和20．2％）。参加合作医疗病人门诊处方中含3～6种药品的比例均高于非参合病人，且其处方中药品费用和治疗总费用也高于非参合病人。结论乡村两级医疗机构的门诊处方中均存在一定程度的不合理、不安全用药现象，应通过规范供方服务行为和购药渠道和改革现行的村医报酬支付机制等措施，以改善乡村两级医疗机构不合理，不安全用药状况。     

Orem自理模式应用于产程管理中的效果探讨

目的:探讨Qrom自理模式在产程管理中的可行性和效果。方法:选择同期拟经阴道分娩产妇200例,其中100例实施常规产时服务模式管理(对照组),100例实施自理模式管理(自理组),比较两组产妇的分娩结局、产时干预情况、产妇满意度和助产士满意度。结果:自理组无指征剖宫产率、椎管内麻醉镇痛率、全程导乐陪伴率、催产素使用率明显低于对照组,产妇满意度和助产士满意度高于对照组。两组上述各项指标比较,差异有显著性或极显著性意义(P<0.05或P<0.01)。结论:O rem自理模式应用于产程管理中可促进自然分娩,减少产时干预,提高产妇和助产士满意度。     

论新编配体制下军队中小医院的建设与发展

分析和总结了军队中小医院在现行人员编配体制下,医院在管理、经营和发展中面临的主要问题和困难;结合工作实践,从正确认识新编制、积极适应新编制、认真落实新编制三个方面论述了解决问题的办法。     

基于ODS构建医院即时联机分析处理系统的研究

面向医院管理者在日常管理全过程中对信息服务的需求,基于HIS数据资源,研究了应用ODS技术进行数据集成整合的技术方法,提出了在医院HIS数据库基础上建立ODS的策略。     

中山大学药学院药学专业课程体系的改革

介绍了中山大学药学院在药学专业培养目标与教学计划、教学内容与课程体系等方面进行的改革,为综合性大学药学专业的课程体系改革提供了一定的思路和借鉴。     

Mode of delivery in the early preterm infant (<28 weeks)

Elective caesarean section for women in labour with an immature baby might reduce the chances of fetal or neonatal death, but might also increase the risk of maternal morbidity. A review (updated in February 2004) of randomised trials comparing a policy of elective caesarean section versus expectant management with recourse to caesarean section produced six studies involving only 122 women. Differences in fetal outcome did not reach significance, but mothers undergoing elective caesarean section were more likely to have serious morbidity. Scientifically, the evidence remains inadequate. Clinically, the recommendation is that prematurity is not, in itself, an indication for caesarean section. In a survey from Israel, published in December 2004, of 2955 very low birthweight infants born at 24–34 weeks of gestation, the overall caesarean section rate was 51.7%, and the mortality rate among babies prior to discharge was lower after caesarean section (13.2 versus 21.8%). After adjustment using multiple logistic regression, caesarean section had no effect on survival except in a subgroup with amnionitis, and it was again concluded that caesarean section cannot be routinely recommended unless there are other indications. A decision model developed in the USA has compared costs and health outcomes of two options for managing labour at 24 weeks of gestation. The probabilities of both intact survival (16.8 versus 12.9%) and survival with major morbidity (39.2 versus 19.4%) are higher with willingness to perform caesarean section, but less aggressive management is the more cost-effective strategy. Large studies are few and recruitment to such studies is perceived as a major problem. For clinicians, the decision will be influenced by local circumstances.     

Safety of vaginal birth after cesarean delivery.

OBJECTIVE: To compare the outcomes of labor induction in women with a history of 1 cesarean section (CS) who undergo trial of labor. METHODS: A prospective observational study of 702 pregnant women who had 1 previous CS was conducted at Women's Hospital, Hamad Medical Corporation, Doha, Qatar, between April 2003 and April 2004. Those with no history of vaginal delivery were assigned to one group and those with a history of vaginal delivery were assigned to another group, and the latter group was then divided into 2 subgroups according to the results of trial of labor. RESULTS: Of these 702 women with a history of 1 CS, 62.4% also had a history of vaginal delivery. After trial of labor, vaginal delivery occurred more often among women with no history of vaginal delivery (64.8%). Moreover, trial of labor resulted in a vaginal delivery more often in women who were delivered only once and by CS (87.7%) than in women who also had a history of vaginal delivery (79.2%). CONCLUSION: These findings indicate that women who have had a CS should strongly consider natural delivery for subsequent pregnancies.     

Levonorgestrel-releasing intrauterine system vs. transcervical endometrial resection for dysfunctional uterine bleeding.

OBJECTIVE: To compare the acceptability, efficacy, adverse effects, and user satisfaction of a levonorgestrel intrauterine system (LNG-IUS) and transcervical resection of the endometrium (TCRE) for the treatment of dysfunctional uterine bleeding. METHOD: Of 50 women with a pictoral blood loss assessment chart (PBAC) score of 100 or greater, 25 had a LNG-IUS inserted (Mirena; Schering, Berlin, Germany) and 25 underwent TCRE. Procedure-related complications, PBAC score, hemoglobin levels, adverse effects, and rates of acceptability and satisfaction were recorded at 3-month intervals for a period of 12 months. RESULTS: At the end of 1 year there were a 97% and a 94% reduction in menstrual blood loss in the LNG-IUS and TCRE groups, respectively, and hemoglobin concentration had increased by 5.5% in the LNG-IUS group and 5.2% in the TCRE group. Adverse effects were similar in both groups except for systemic effects, which were seen only in the LNG-IUS group. Satisfaction rates were about 80% in the 2 groups. CONCLUSION: Both treatments were found to be equally effective but LNG-IUS placement requires less operator skill and entails no operative hazards, and the device provides effective contraception.