Does an oral analgesic protocol improve pain control for patients with cancer? An intergroup study coordinated by the Eastern Cooperative Oncology Group

BACKGROUND: Cancer pain is highly prevalent and commonly undertreated. This study was designed to determine whether dissemination of a clinical protocol for pain management would improve outcomes in community oncology practices. PATIENTS AND METHODS: A pain management protocol was developed based on accepted guidelines. After baseline assessment, oncology practices were randomly assigned to 'analgesic protocol' (AP) sites, where oncologists implemented the guidelines in a group of lung or prostate cancer patients, or to 'physician discretion' (PD) sites, where customary treatment was continued. Patients treated on protocol and a comparison group of patients with pain due to breast cancer or myeloma were monitored for change in pain using the Brief Pain Inventory, and for change in other symptoms or mood. RESULTS: The protocol terminated early because of poor accrual. We compared groups using proportions of patients who had no or mild pain at follow-up. Although measures of protocol adherence did not suggest the occurrence of major practice change, the proportion of lung or prostate cancer patients with no or mild pain increased significantly from baseline for those treated at AP sites compared with those treated at PD sites. There was no significant difference between the breast and myeloma patients treated at AP sites versus those treated at PD sites. CONCLUSION: A protocol for cancer pain management can improve pain control. Diffusion of these benefits to other patients was not confirmed. Given the small sample size, these findings require confirmation in a larger trial.     

瞄准前沿以人为本全面提升医院的综合竞争力

介绍了医院创新工作思路和瞄准国际前沿,高起点培训专业技术人才,全面提升医院综合竞争力的主要做法及取得的成效.     

提高卫生院管理水平改善卫生院服务质量--陕西省项目区卫生服务管理水平分析

目的对陕西省世界银行贷款卫生Ⅷ项目利用日本赠款改善乡镇卫生院基本卫生服务情况进行分析。方法采用访谈、参与性评估以及资料复习等。结果项目县的卫生院服务供给状况得到了改善．提高了卫生院管理水平．增强了卫生服务能力，提高了服务效率，特困人口医疗救助(MFA)实施效果得到提高。但是存在配套资金不到位的问题，应加大特困人口医疗救助工作的宣传力度。建议加大项目管理力度，完善项目监督机制，推广示范点经验。     

浅谈综合性医院目标成本管理

医院目标成本管理是医院经营管理的重点,本文讨论了目标成本管理的相关概念和内涵,阐述了医院目标成本管理的特点和作用,在此基础上,提出了加强医院目标成本管理的思路。     

对医院药事管理委员会系统工程管理的初探

本文通过对医院药事管理委员会的组织形式以及在医院药学事业中的特殊地位、工作任务、工作职责及职能效应的初步探讨,指出医院药事管理委员会在发展和建设医院药学事业中具有十三种职能、七大效应。认为加强医院药事管理委员会建设,是发展医院药学事业和保证医院药品质量的一种好方式。     

特殊药品管理方法探讨

笔者结合单位的做法和体会,对医疗单位等在特殊药品使用管理中存在的问题,提出特殊药品的管理应法制化、职责化、程序化、档案化及提高业务素质、奖优罚劣的管理方法。     

大型医用设备成本效益分析在HIS上的实现

介绍了大型医疗设备成本效益分析应用系统挂接HIS(“军字一号”)上的设计、功能实现及应用。该应用系统部分实现了大型医用设备的现代经济管理。     

用科学理论指导"五四一"医院经营管理模式的研究

本文介绍了广东省第二人民医院,用科学理论指导"五四一"医院经营管理模式研究的改革实践.分别阐述了"五四一"医院经营管理模式的研究基础、方向和核心目标.     

Health promotion and environmental management: a partnership for the future

Health Promotion as a professional practice is facing its thirdmajor challenge this century. To the infectious diseases ofthe past and the lifestyle risks of the present have been addedthe global environmental hazards of the future. Each wave of health risk has three things in common. The firstis that ill-health results from a change in the relationshipbetween the environment and society. The second is that theill-health so caused falls predominantly on already disadvantagedgroups in the community. Third in each case there is a tunelag of two or more decades between recognition of the freshrisks to health and effective professional response. The challengetoday is to shorten the lead time for responding to the thirdphase, the degradation of the global environment. This willgive a radical reorientation to the field of health promotion,which has traditionally safe guarded the health of people fromenvironmental change, not vice versa. The reorientation of health promotion is discussed in termsof the contributions which health promotion can make to environmentalmanagement. The options for managing environmental change areidentified as protection, prevention, resilience and adaptation.These strategies are already in use in the different branchesof health promotion.     

加强保健措施 降低孕产妇死亡率的试点研究

经调查河南省七县1988～04～1989～03孕产妇死亡率为136.1/10万,高于全国平均水平(94.7/10万)。从七县中选择了死亡率偏高的三个县(147.9/10万)为样本.进行厂降低农村孕产妇死亡率保健措施的研究。自1990年4月1日～1992年3月31日。在三县采取了以下保健措施:①加强基层妇幼卫生建设,特别是中心乡卫生院的建设,②整顿和完善三级保健网;③建全孕产妇系统管理制度,高危妊娠筛查,转化和转诊制度,④配备必要设备,建立联合小产院,实行定点接生。两年内孕产妇死亡率,由1989年的147.9/10万下降到67.7/10万,下降幅度为54.44%,最高达72.1%。此工作为实现2000年孕产妇死亡率下降一半的规划目标提供了依据。