现代医院医疗设备的合同标准化管理

目的本文主要阐述现代医院在医疗设备购置过程中,怎样来进一步规范采购合同,制定标准合同,加强标准合同管理,防范采购风险。     

当代医院大型医疗设备维修存在问题与对策探析

目的:探讨医院大型医疗设备在维修过程中所暴露的问题,并提出相应的解决对策。方法:选取我院2012年4月至2013年4月间采购及正常使用的大型医疗设备60台,通过观察和探讨设备维修中的问题,提出对应的问题解决方案。结果:大型医疗设备在维修过程中面临资金匮乏、技术陈旧等突出问题,要通过制度完善、人才培养、技术改造及定期维修等方面加以努力解决。结论:大型医疗设备尽管存在的问题较多,但均是可控的,医院要积极重视设备维修中的问题,确保使用安全、可靠。     

医院医疗器械维修中存在的问题及维修管理对策研究

近几年来,随着科学技术的发展和医院规模的扩大,社会对医疗技术要求不断提高,因此,高端医疗器械和新型医疗设备需求加大,医疗器械管理与维修也需跟进。医疗器械的正常使用在医疗工作中有着举足轻重的作用,可提高医疗人员的工作效率,提升临床诊治的水平,但其在改善医疗条件的同时也存在一系列的问题,若无法保质和及时维修医疗器械,对正常医疗设备的使用具有严重影响,延误患者的就诊与治疗。目前医院医疗器械维修中存在的维修人员整体素质偏低、管理机制不健全、维修技术落后、医疗器械维修人员不足、缺乏积极性及再学习的机会、医疗器械缺乏定期保养和管理等实际问题,导致医疗器械维修效率低,本文就以上问题展开讨论,旨在为医院维修管理的制定提供参考。     

浅谈医疗设备维修管理模式与实践

随着医疗事业单位的不断发展和完善,大部分医院都具有较为完善的医疗设备,可协助医生完成诊断及治疗工作。为降低医疗设备的维修成本,方便就诊,提高医疗质量,本文主要探讨医疗设备维修管理模式与实践。     

浅谈设备维修人员的应急能力

先进的医疗仪器是现代化医院的重要组成部分,及时做好医疗仪器的维修工作是充分发挥医疗仪器作用的保证。医疗仪器维修质量的高低,直接影响到仪器完好率和使用率,也是医院医疗工作正常运转的保证。随着中国现代化建设不断发展,一些县级医院医疗设备不断增添和更新,各种高、精、尖技术进口设备应用到临床,伴随而来的维修人员队伍也越来越大。这些年来实践证明,维修人员在对支持临床医疗工作中起着重要的作用,但由于维修技术队伍素质差,技术水平低,难以适应换代产品的技术进展。目前医疗设备进入以电脑芯片控制为重要模式的大规模集成电路时代,而我们的维修人员多数仍停留在晶体管时代,个别的处于电工水平,从技术发展阶段来看,已落后一个时代,不能发挥应有的作用。从全局来看,在新技术日新月异的今天,我们设备维修人员面临如何提高技术素质的迫切任务。因此现在完全有必要提出加强“应急能力”的训练。     

医疗设备软件维修与调整

介绍了医疗设备软件维修必须具备的知识,DSA机与培养仪软件维修实例。同时还介绍了医疗设备的调整的方法,用于排除故障的经验。     

上海首届医疗器械职业培训班开学

由上海第二医科大学继续教育学院、上海沪市医疗器械维修培训中心承办的《医用电子仪器维修师、医用放射线设备维修师资格认证》试培训工程全面启动。以各级医院管理和维修保养医疗设备的技术人员和管理人员（设备科、放射科、工程部的从业人员）等为对象的职业培训工作,配合推广实施“医疗器械维修人员职业技能等级标准资格认证”进行专业人员培训。参加培训者经鉴定合格可在中国首批取得由中华人民共和国劳动与保障部颁发的“国家级职业资格证书”。     

浅谈医疗设备的预防性维护

随着人们生活水平的不断提高,对自身的生活质量（包括身体健康状况）的要求也越来越高,这也要求医院医疗设备必须处在随时能及时提供服务的状态。而医疗设备随着使用日期的增加,在使用二年后会进入一个故障高发期即U字型的俗称“澡盆曲线”周期。而医疗设备的Maintenance／维护、Repair／维修时效性和质量,     

基于物联网技术的医疗设备管理

医疗设备管理是医院内部管理的重点之一,影响着整个医院的综合管理水平。传统的医疗设备管理方法在越来越多的设备和越来越大的资产金额面前容易造成管理工作量大、设备利用率低下、资产盘点困难甚至设备流失等问题。对医疗设备管理现状进行了探讨,在考虑成本的前提下设计了一个新型的基于物联网技术的设备管理系统。此系统根据设备的价值高低分为高值设备管理系统、中高值设备管理系统和低值设备管理系统3个子系统和一个控制中心。3个子系统拥有同一个控制中心,统一对设备的出入库、维修、调配等进行管理。系统正在深圳市人民医院进行实施部署,将有效提升医院设备管理效率。     

心电监护仪故障维修及养护

心电监护设备是现代医学必不可缺的仪器设备,是科技在医疗实践中的具体应用,是每个医院必须具备的硬件设施,尤其是相关科室的重症监护室更是不能缺少心电监护仪的。正确地维修及有效的养护能延长使用寿命,提高临床对心电监护仪的使用效率。本文旨在对现代心电监护仪的故障维修及心电监护仪的养护综述如下。     

Medical education and society.

As health care changes under the pressures of restraint and constraint our vision of the future of medical education should be based on the medical school''s responsibility to the community. The medical school is "an academy in the community": as an academy, it fosters the highest standards in education and research; as an institution in the community, it seeks to improve public health and alleviate suffering. The author argues that to better achieve these goals medical schools need to become more responsible and responsive to the population they serve. Medical schools have been slow to accept fully the social contract by which, in return for their service to society, they enjoy special rights and benefits. This contract requires that medical educators listen to the public, talk honestly and constructively with government representatives and assess the needs and expectations of the community.     

海洋药用动物海龙的研究

海龙是一种重要的海洋中药 ,具有激素样、抗疲劳、抗癌等作用 ,提高机体免疫力 ,使心肌细胞收缩力增强等生理功能。在水产养殖、食品和医药等领域应用前景广阔。对海龙的分类、产地、成分分析以及海龙的药用价值进行综述。     

19th-century academic examinations for physicians in the United States Army Medical Department.

During the latter half of the 19th century, the United States Army commissioned medical officers or hired civilian physicians to serve its troops. The civilian physician signed a contract for services, and the candidate for a commission was subjected to rigorous examinations before becoming an officer. The rigorous testing of prospective medical officers was necessary because of the lack of standardization in the education of physicians. Examples of the test, statistics, and individual records show how the Army dealt with unqualified candidates.     

Medical professionalism and the social contract

Conceptions of professionalism in medicine draw on social contract theory; its strengths and weaknesses play out in how we reason about professionalism. The social contract metaphor may be a heuristic device prompting reflection on social responsibility, and as such is appealing: it encourages reasoning about privilege and responsibility, the broader context and consequences of action, and diverse perspectives on medical practice. However, when this metaphor is elevated to the status of a theory, it has well-known limits: the assumed subject position of contractors engenders blind spots about privilege, not critical reflection; its tendency to dress up the status quo in the trappings of a theoretical agreement may limit social negotiation; its attempted reconciliation of social obligation and self-interest fosters the view that ethics and self-interest should coincide; it sets up false expectations by identifying appearance and reality in morality; and its construal of prima facie duties as conditional misdirects ethical attention in particular situations from current needs to supposed past agreements or reciprocities. Using philosophical ideas as heuristic devices in medical ethics is inevitable, but we should be conscious of their limitations. When they limit the ethical scope of debate, we should seek new metaphors.     

综合性大学医学院细胞生物学教学改革实践

就如何提高综合性大学医学院校中细胞生物学的教学质量进行了讨论,从如何合理组织优化教学内容,充分应用现代教学手段和教学方法提高课堂教学效果,开展实践性教学环节的改革,不断提高学生的分析问题和解决问题的能力等方面介绍了细胞生物学教学改革的方法和措施,并就如何进一步提高教学质量、激发学生学习积极性等方面进行探讨。     

Multiobjective long-term planning of biopharmaceutical manufacturing facilities

Biopharmaceutical companies with large portfolios of clinical and commercial products typically need to allocate production across several multiproduct facilities, including third party contract manufacturers. This poses several capacity planning challenges which are further complicated by the need to satisfy different stakeholders often with conflicting objectives. This work addresses the question of how a biopharmaceutical manufacturer can make better long-term capacity planning decisions given multiple strategic criteria such as cost, risk, customer service level, and capacity utilization targets. A long-term planning model that allows for multiple facilities and accounts for multiple objectives via goal programming is developed. An industrial case study based on a large scale biopharmaceutical manufacturer is used to illustrate the functionality of the model. A single objective model is used to identify how best to use existing capacity so as to maximize profits for different demand scenarios. Mitigating risk due to unforeseen circumstances by including a dual facility constraint is shown to be a reasonable strategy at base case demand levels but unacceptable if demands are 150% higher than expected. The capacity analysis identifies where existing capacity fails to meet demands given the constraints. A multiobjective model is used to demonstrate how key performance measures change given different decision making policies where different weights are assigned to cost, customer service level, and utilization targets. The analysis demonstrates that a high profit can still be achieved while meeting key targets more closely. The sensitivity of the optimal solution to different limits on the targets is illustrated.     

Moving Toward Patient-Centered Care in Africa: A Discrete Choice Experiment of Preferences for Delivery Care among 3,003 Tanzanian Women

Objective

In order to develop patient-centered care we need to know what patients want and how changing socio-demographic factors shape their preferences.

Methods

We fielded a structured questionnaire that included a discrete choice experiment to investigate women’s preferences for place of delivery care in four rural districts of Pwani Region, Tanzania. The discrete choice experiment consisted of six attributes: kind treatment by the health worker, health worker medical knowledge, modern equipment and medicines, facility privacy, facility cleanliness, and cost of visit. Each woman received eight choice questions. The influence of potential supply- and demand- side factors on patient preferences was evaluated using mixed logit models.

Results

3,003 women participated in the discrete choice experiment (93% response rate) completing 23,947 choice tasks. The greatest predictor of health facility preference was kind treatment by doctor (β = 1.13, p<0.001), followed by having a doctor with excellent medical knowledge (β = 0.89 p<0.001) and modern medical equipment and drugs (β = 0.66 p<0.001). Preferences for all attributes except kindness and cost were changed with changes to education, primiparity, media exposure and distance to nearest hospital.

Conclusions

Care quality, both technical and interpersonal, was more important than clinic inputs such as equipment and cleanliness. These results suggest that while basic clinic infrastructure is necessary, it is not sufficient for provision of high quality, patient-centered care. There is an urgent need to build an adequate, competent, and kind health workforce to raise facility delivery and promote patient-centered care.     

New standards,new dilemmas--reflections on managing medical mistakes

This article describes one hospital's development of a proactive, patient centered program, which emphasizes total honesty in dealing with all aspects of patient care. This process includes the full and timely disclosure of errors which affect the patient's health and well being. The article describes the process by which the medical facility identifies errors and works with healthcare providers to arrive at a consensus on the management of these errors. Included is a step by step analysis of how disclosure can be successfully accomplished.     

Facility Death Review of Maternal and Neonatal Deaths in Bangladesh

Objectives

To explore the experiences, acceptance, and effects of conducting facility death review (FDR) of maternal and neonatal deaths and stillbirths at or below the district level in Bangladesh.

Methods

This was a qualitative study with healthcare providers involved in FDRs. Two districts were studied: Thakurgaon district (a pilot district) and Jamalpur district (randomly selected from three follow-on study districts). Data were collected between January and November 2011. Data were collected from focus group discussions, in-depth interviews, and document review. Hospital administrators, obstetrics and gynecology consultants, and pediatric consultants and nurses employed in the same departments of the respective facilities participated in the study. Content and thematic analyses were performed.

Results

FDR for maternal and neonatal deaths and stillbirths can be performed in upazila health complexes at sub-district and district hospital levels. Senior staff nurses took responsibility for notifying each death and conducting death reviews with the support of doctors. Doctors reviewed the FDRs to assign causes of death. Review meetings with doctors, nurses, and health managers at the upazila and district levels supported the preparation of remedial action plans based on FDR findings, and interventions were planned accordingly. There were excellent examples of improved quality of care at facilities as a result of FDR. FDR also identified gaps and challenges to overcome in the near future to improve maternal and newborn health.

Discussion

FDR of maternal and neonatal deaths is feasible in district and upazila health facilities. FDR not only identifies the medical causes of a maternal or neonatal death but also explores remediable gaps and challenges in the facility. FDR creates an enabled environment in the facility to explore medical causes of deaths, including the gaps and challenges that influence mortality. FDRs mobilize health managers at upazila and district levels to forward plan and improve healthcare delivery.