三甲综合医院住院医师职业倦怠现状调查与影响因素分析

目的:探究三甲综合医院住院医师职业倦怠的发生现状及其影响因素,为预防三甲综合医院住院医师发生职业倦怠提供依据。方法:选择三甲综合医院各临床住院医师218名为研究对象,采用问卷调查住院医师性别、年龄、文化程度、职务、婚姻状况、职称、工作时间、编制及身体健康情况等基线资料及职业倦怠程度,采用logistics回归分析住院医师职业倦怠的影响因素。结果:218例三甲住院医师中119例人(54.59%)发生职业倦怠,其中轻度倦怠者60人(27.52%),中度倦怠者49人(22.48%),重度倦怠者10人(4.59%);身体健康状况一般、差(OR=1.547,5.342;P0.05)是住院医师发生职业倦怠的危险因素,职称为初级、中级、副高及以上(OR=0.893,0.827,0.736;P0.05)是住院医师发生职业倦怠的保护因素。结论:三甲住院医师职业倦怠发生的现状不容乐观,无编制、身体健康状况一般、差是住院医师发生职业倦怠的危险因素,职称为初级、中级、副高及以上是住院医师发生职业倦怠的保护因素。     

Occupational health and safety risk assessment in hospitals: A case study using two-stage fuzzy multi-criteria approach

Occupational Health and Safety (OHS) is a basis to reduce occupational accidents in an acceptable level, and it covers employee health, safety, and welfare in the workplaces. Hospitals as the largest employer group in healthcare industry in Turkey face major hazards categorized as chemical, biological, physical, ergonomic, and psychosocial risks. Although Turkey demonstrates rapid economic growth, OHS practices have not been fully put into practice, and necessary attention has not been paid to the health industry. For this reason, this paper aims to assess risks for health staff, contribute for planning of health services, and enhance regulations. A case study was carried out in a leading hospital in Turkey using a two-stage fuzzy multi-criteria approach, which provides more consistency in decision-making process and gives an appropriate final rank of hazard types. Fuzzy Analytic Hierarchy Process (FAHP) is used in weighing five risk parameters, which are severity, occurrence, undetectability, sensitivity to maintenance non-execution, and sensitivity to personal protective equipment (PPE) non-utilization. The fuzzy VIKOR (FVIKOR) approach is then applied for prioritization of hazard types in each department of the hospital. On conclusion of the hazard control hierarchy, measures are overtaken for the hazards, and areas open for improvement are presented.     

完善公立医院补偿机制改革的难点与思考

补偿机制改革是公立医院改革的重点和难点。在分析当前公立医院财政补助现状以及取消药品加成的影响的基础上,指出当前补偿途径在具体实施过程中还存在相当的困难。为保障公立医院补偿机制改革的顺利推进,应从医疗服务的公平性和效益出发,明确补偿范围,制定补偿标准,并在机制体制上确保补偿到位。     

基于PEST模型的非营利性医院筹资宏观环境分析

用宏观政策分析、PEST分析方法,对我国非营利性医院筹资相关的政治、经济、社会、技术等方面的影响因素及各利益相关主体的作用进行综合分析;发现政府对民生问题的关注改善了整个医疗卫生体系的发展环境,而新的医疗体制改革方案将带来现有卫生体系利益格局的重大调整,基层医疗服务体系、基本医疗保障体系、基本药物制度的建立都将对医院内部资金积累带来限制,政府主导多元投入体制的建立将为医院多渠道筹资创造更宽松的环境。     

Patient dose levels for seven different radiographic examination types

This study was carried out as a part of a comprehensive project to establish a national diagnostic reference level (NDRL), for the first time, in Saudi Arabia. Seven of the most common X-ray examinations (10 projections) were included. This study consisted of 200 patients who were referred for X-ray examinations at King Khalid University Hospital (KKUH). The selected X-ray examinations were skull (PA), kub (AP and LAT), ankle (AP and LAT), foot (AP/OBL and LAT/OBL), hib (AP and LAT) and sinuses paranasal (AP). Mean patient information and exposure parameters for these seven radiographic examinations were recorded at KKUH. Some of these radiographic examinations were compared with their corresponding values at other national places [Security Forces Hospital (SFH); King Abdulaziz City for Science and Technology (KACST)] in Saudi Arabia. We found that the patient mean dose values recorded at KKUH were varied from those recorded at other national places. Wide variations in patient dose arising from a specific type of X-ray examination at different national places suggests that significant reductions in patient dose would be possible without affecting image quality. Furthermore, variations in patient dose may emerge from the examination technique, clinical condition, radiologist skill, tube current, tube potential and focus to film distance. The data of this study will be useful for the formulation of NDRLs, and it is also provides local diagnostic reference levels for some diagnostic X-ray examinations at KKUH and other national places in Saudi Arabia.     

CURRENT FUNCTIONS OF ITALIAN ETHICS COMMITTEES: A CROSS‐SECTIONAL STUDY

Background: The rapid pace of progress in medical research, the consequent need for the timely transfer of new knowledge into practice, and the increasing need for ethics support, is making the work of Ethics Committees (ECs) ever more complex and demanding. As a response, ECs in many countries exhibit large variation in number, mandate, organization and member competences. This cross‐sectional study aims to give an overview of the different types of activities of Italian ECs and favour discussion at a European level. Methods: A questionnaire was emailed to all Italian Ethics Committees contained in the national Registry of the Ministry of Health, enquiring whether the EC was conducting, or planning to conduct, 4 specific activities. A telephone interview was conducted to determine reasons for failure to respond. Results: Response rate was 53% (101 respondents out of 191). 20% of ECs restrict their responsibilities to research protocol review, 25% also offer ethical consultation to institutions, support on individual health care decisions and promotes educational initiatives, while the remaining 50% conduct a few of the examined activities to varying degrees. Large variation was observed across different types of hosting institutions and geographical locations. Conclusions: A common European model should be developed, defining EC functions, member selection modalities, necessary member competences, decision‐making criteria and measures for work verification. In the absence of sound empirical evidence, it would be interesting to study the effectiveness and efficiency of the different existing models.