应用数据包络分析方法评价医院临床科室相对效率的探讨

目的 利用数据包络分析方法评价厦门市某三级综合性医院临床科室的配置效率，为医院管理者提供有益的决策信息。方法 在Excel的规划求解模块上进行数据包络分析计算，得出各临床科室的相对效率得分。结果 数据包络分析有效单元为15个，其余单元不同程度存在产出不足的现象。结论 大型综合性医院在自身的生存和发展中，应注重以资源调整和优化配置为主的内涵式发展。     

基于知识库和商业智能的临床用药指引及监测系统

目的 有效规范临床用药，进行合理用药指标的监控，降低临床用药风险。方法 依据临床用药知识库，将用药规范和制度与医嘱系统流程融合；采用商业智能技术，抽取医院管理、医嘱、检验等临床业务数据库，建立主题模型，监测临床用药的各项指标。结果 软件化定制了临床用药规范和制度，在医嘱系统中实现提醒和审批流程。实时、精细化展示合理用药指标报表，并能进行潜入分析。结论 减少不合理用药医嘱，同时极大提高了合理用药数据统计、分析的效果和效率。     

医院绩效考核信息管理系统的建设与思考

医院绩效考核的有效实施有赖于信息化的大力支持。开发建设基于临床数据集成平台的智能化绩效考核信息管理系统,有利于绩效考核数据的准确性和时效性,有利于绩效考核信息的实时分析和动态监管,有利于医院改善服务绩效的正向激励和引导作用,可有效促进绩效考核与分配的科学化、信息化、智能化,实现医院内部绩效考核管理的跨越式发展。

     

基于闭环医嘱的患者临床安全信息保障研究与实践

目的 对医院临床信息系统进行改造和完善,进行患者临床安全信息保障体系理论研究。方法 结合医院信息化实际,针对药品、护理、手术、检查、检验、输血六大类医嘱,分析其流转环节关键节点,进行信息闭环,研究护理执行文档、手术医疗器械以及消毒供应包管理追溯、医技报告危急值报警等信息标准化,建立数据集,实现病人临床安全的信息化支撑。结果 实现了护理文档数据标准化和移动护理数据采集的全面应用,探索了医嘱闭环信息的工程化建设方法,研发了移动护理软件,形成了护理工作绩效评价的新模式。结论 通过项目研究,在国内率先进行了护理文档标准化研究,形成了医嘱闭环执行与护士工作量评价新方法,并在患者临床安全的一系列关键环节进行了信息保障的全面应用。     

以考核准入为基础的三级医院临床实验室生物安全管理模式探讨

目的 探讨医务处在医院临床实验室生物安全管理的模式和作用。方法 建立以考核准入为基础的三级医院临床实验室生物安全管理模式,结合加强实验室生物安全管理委员会作用,完善硬件建设、加强日常监管、定期组织培训讲座、建立健全生物安全应急流程等其他管理措施。结果 以考核准入为基础的三级医院临床实验室生物安全管理模式在实践中运行良好,起到了保障医院实验室生物安全的作用。结论 医务处等医政管理部门通过建立并运行合理的临床实验室生物安全管理模式, 可以有效监督规范医院实验室生物安全工作, 防止和避免生物安全事故的发生。     

信息管理系统在医院绩效考核分配中的应用研究

建立和完善医院内部绩效考核和收入分配制度,坚持公立医院公益性,是深化公立医院改革的一项重要内容;依托医院信息平台,开发建设基于临床数据仓库的智能化医院绩效考核分配信息管理系统,是各医院推进精细化管理所面临的重要课题。本文分析了信息管理系统在国内外医院内部绩效考核中的应用,剖析存在的问题,并提出了相应的建议和对策。     

基于医疗联合体的区域医疗信息平台建设

以医疗联合体为依托,建立区域医疗信息平台。其平台系统集成并共享各医疗机构的诊疗信息,对居民在各医疗机构的诊疗信息进行系统、连贯的有机整合;系统制定规范的分级诊疗流程、上转诊间预约、下转自动推送机制;在区域医疗联合体内部层级医疗机构内,提供远程会诊、在线医学教育、病患健康宣教、区域临床统一知识库、居民电子健康档案、诊疗预约、信息共享服务。     

大型综合性医院协同管理模式研究

管理信息化对提高医院管理水平有重要意义。直线式管理结构和复杂行政流程,与当前医院快速发展有许多不适应之处。文章阐述了如何利用信息技术在医院管理中引入协同的理念,通过公开、分析和挖掘有用信息,加强信息的反馈与再利用、建立信息流通的环路,实现人、数据、和流程的协调运作,从而最终实现医院透明化与精细化管理,提高工作效率,打造坚实的医院品牌。     

临床检验后阶段质量指标及其质量规范

目的 探讨我国当前检验后阶段的质量指标及其质量规范,为临床实验室建立QI体系提供参考。 方法 采用卫生部临床检验中心和北京科临易检信息技术有限公司共同设计开发的网络平台,向参加中心2015年全国临床检验专业质量指标调查的所有实验室发放调查表按照不同专业和不同医院等级进行分组,采用Kolmogorov-Smirnov检验判断数据正态性,Kruskal-Wallis检验和Mann-Whitney检验分别进行多组和两组间的比较。结果 分别有5 229家、4 643家和4 421家实验室上报了检验报告不正确率、危急值通报率和危急值通报及时率的相关数据。各指标均有超过95%的实验室、σ水平≥3 σ和≥6 σ的实验室则分别占47.87%、91.17%、85.95%。各指标在不同专业之间存在显著差异;除危急值通报率以外,其余2项指标在不同等级医院之间也存在显著差异。结论 我国临床实验室检验后阶段3项QI的差错率相对较低,多数实验室危急值通报率和危急值通报及时率达到了100%。临床实验室应基于此调查,进一步监测3项指标,同时正确有效地识别检验后阶段的薄弱环节,建立更多合适的QI并基于当前技术水平确定相应的质量规范。     

数据包络分析在临床科室绩效管理中的应用

目的 通过总结数据包络分析在临床科室效率测算中的应用,为医院绩效管理提供一种量化管理技术。方法 应用数据包络分析测算临床科室的相对效率、生产率变化率。通过对测算结果的描述分析,得到临床科室的效率评价结果。将数据测算及分析结果与职能科室管理者对临床科室效率的定性评价进行比较。结果 测算数据的描述分析结果与临床科室绩效的管理者评价具有一致性。结论 数据包络分析在医院临床科室绩效管理中具有实际应用价值、是绩效管理者的有效管理技术。     

On the ontogeny of the haptor and the evolution of the Monogenea

Data on the ontogeny of the posterior haptor of monogeneans were obtained from more than 150 publications and summarised. These data were plotted into diagrams showing evolutionary capacity levels based on the theory of a progressive evolution of marginal hooks, anchors and other attachment components of the posterior haptor in the Monogenea (Malmberg, 1986). 5 + 5 unhinged marginal hooks are assumed to be the most primitive monogenean haptoral condition. Thus the diagrams were founded on a 5 + 5 unhinged marginal hook evolutionary capacity level, and the evolutionary capacity levels of anchors and other haptoral attachement components were arranged according to haptoral ontogenetical sequences. In the final plotting diagram data on hosts, type of spermatozoa, oncomiracidial ciliation, sensilla pattern and protonephridial systems were also included. In this way a number of correlations were revealed. Thus, for example, the number of 5 + 5 marginal hooks correlates with the most primitive monogenean type of spermatozoon and with few sensillae, many ciliated cells and a simple protonephridial system in the oncomiracidium. On the basis of the reviewed data it is concluded that the ancient monogeneans with 5 + 5 unhinged marginal hooks were divided into two main lines, one retaining unhinged marginal hooks and the other evolving hinged marginal hooks. Both main lines have recent representatives at different marginal hook evolutionary capacity levels, i.e. monogeneans retaining a haptor with only marginal hooks. For the main line with hinged marginal hooks the name Articulon-choinea n. subclass is proposed. Members with 8 + 8 hinged marginal hooks only are here called Proanchorea n. superord. Monogeneans with unhinged marginal hooks only are here called Ananchorea n. superord. and three new families are erected for its recent members: Anonchohapteridae n. fam., Acolpentronidae n. fam. and Anacanthoridae n. fam. (with 7 + 7, 8 + 8 and 9 + 9 unhinged marginal hooks, respectively). Except for the families of Articulonchoinea (e.g. Acanthocotylidae, Gyrodactylidae, Tetraonchoididae) Bychowsky's (1957) division of the Monogenea into the Oligonchoinea and Polyonchoinea fits the proposed scheme, i.e. monogeneans with unhinged marginal hooks form one old group, the Oligonchoinea, which have 5 + 5 unhinged marginal hooks, and the other group form the Polyonchoinea, which (with the exception of the Hexabothriidae) has a greater number (7 + 7, 8 + 8 or 9 + 9) of unhinged marginal hooks. It is proposed that both these names, Oligonchoinea (sensu mihi) and Polyonchoinea (sensu mihi), will be retained on one side and Articulonchoinea placed on the other side, which reflects the early monogenean evolution. Except for the members of Ananchorea [Polyonchoinea], all members of the Oligonchoinea and Polyonchoinea have anchors, which imply that they are further evolved, i.e. have passed the 5 + 5 marginal hook evolutionary capacity level (Malmberg, 1986). There are two main types of anchors in the Monogenea: haptoral anchors, with anlages appearing in the haptor, and peduncular anchors, with anlages in the peduncle. There are two types of haptoral anchors: peripheral haptoral anchors, ontogenetically the oldest, and central haptoral anchors. Peduncular anchors, in turn, are ontogenetically younger than peripheral haptoral anchors. There may be two pairs of peduncular anchors: medial peduncular anchors, ontogentically the oldest, and lateral peduncular anchors. Only peduncular (not haptoral) anchors have anchor bars. Monogeneans with haptoral anchors are here called Mediohaptanchorea n. superord. and Laterohaptanchorea n. superord. or haptanchoreans. All oligonchoineans and the oldest polyonchoineans are haptanchoreans. Certain members of Calceostomatidae [Polyonchoinea] are the only monogeneans with both (peripheral) haptoral and peduncular anchors (one pair). These monogeneans are here called Mixanchorea n. superord. Polyonchoineans with peduncular anchors and unhinged marginal hooks are here called the Pedunculanchorea n. superord. The most primitive pedunculanchoreans have only one pair of peduncular anchors with an anchor bar, while the most advanced have both medial and lateral peduncular anchors; each pair having an anchor bar. Certain families of the Articulonchoinea, the Anchorea n. superord., also have peduncular anchors (parallel evolution): only one family, the Sundanonchidae n. fam., has both medial and lateral peduncular anchors, each anchor pair with an anchor bar. Evolutionary lines from different monogenean evolutionary capacity levels are discussed and a new system of classification for the Monogenea is proposed.In agreeing to publish this article, I recognise that its contents are controversial and contrary to generally accepted views on monogenean systematics and evolution. I have anticipated a reaction to the article by inviting senior workers in the field to comment upon it: their views will be reported in a future issue of this journal. EditorIn agreeing to publish this article, I recognise that its contents are controversial and contrary to generally accepted views on monogenean systematics and evolution. I have anticipated a reaction to the article by inviting senior workers in the field to comment upon it: their views will be reported in a future issue of this journal. Editor     

On the origin of the Hirudinea and the demise of the Oligochaeta

The phylogenetic relationships of the Clitellata were investigated with a data set of published and new complete 18S rRNA gene sequences of 51 species representing 41 families. Sequences were aligned on the basis of a secondary structure model and analysed with maximum parsimony and maximum likelihood. In contrast to the latter method, parsimony did not recover the monophyly of Clitellata. However, a close scrutiny of the data suggested a spurious attraction between some polychaetes and clitellates. As a rule, molecular trees are closely aligned with morphology-based phylogenies. Acanthobdellida and Euhirudinea were reconciled in their traditional Hirudinea clade and were included in the Oligochaeta with the Branchiobdellida via the Lumbriculidae as a possible link between the two assemblages. While the 18S gene yielded a meaningful historical signal for determining relationships within clitellates, the exact position of Hirudinea and Branchiobdellida within oligochaetes remained unresolved. The lack of phylogenetic signal is interpreted as evidence for a rapid radiation of these taxa. The placement of Clitellata within the Polychaeta remained unresolved. The biological reality of polytomies within annelids is suggested and supports the hypothesis of an extremely ancient radiation of polychaetes and emergence of clitellates.