后医改时期医院后勤社会化管理存在的问题与对策

随着医改的深化与推进,医院后勤既有的供给式服务模式弊端日渐突显,旧观念与新形势的冲突引发一系列新型后勤管理问题。因此,要从根本上“治愈”医院后勤管理的顽疾,必须从转变思想开始,进而改革现有的运行机制、人才任用与培养模式和建立完整而有力的规章制度。     

住院病人对医疗机构的评价及影响患者不满意的因素分析

目的 了解住院病人的看法,为提高患者满意度,促进医患和谐提供参考。方法 利用2008年第4次国家卫生服务调查的数据,用描述性方法和Logistic回归,分析住院病人对所住医院的评价以及影响住院病人不满意的因素。结果 一半以上的住院病人比较满意。费用高、设备差、手续繁琐、态度差是最不满意的4个方面。收入、住院时间、自费高低等因素会影响患者满意。 结论 提高住院患者满意度,改善医患关系需要医、患、政府三方共同努力。     

门诊患者医疗服务感受度影响因素研究

??????? 目的 了解门诊患者对就医服务感受度影响因素,以期提高患者满意度。 方法 现场问卷调查法、专家访谈法。 结果 患者在门诊过程中最为关注的就诊流程、等候时间、就医环境、医德医风四个因素,非常看重医护人员服务规范,服务流程便捷流畅。病情不同患者对等候时间要求不同,对医院熟悉程度与就诊环境感受度不同。结论 在门诊服务中为患者提供便捷流畅、规范化的服务,同时应注重患者的不同服务需求。     

基于循证评价的现代化综合性中医院医疗质量评价指标体系的建立

目的 建立一套科学合理、量化可比、简便易行的现代化综合性中医院医疗质量评价指标体系。方法 对我国现有的医疗质量评价的文献进行循证分析,按循证医学的标准和引用频率提取综合性医院的共性指标和中医院特有的非共性指标,从而拟定指标体系草案。运用德尔菲法,进行3轮专家咨询,采用相乘模型的综合指数法筛选指标,用层次分析法和比例分配法确定指标权重。结果 指标体系由5个一级指标、23个二级指标构成,其中反映中医院特色的二级指标6个,占26%。结论 整套指标体系既有医院的共性指标,又强调了综合性中医院的特性指标,既能突出中医医疗质量管理与质量控制的特色,又能结合中医医院现代化发展的需要。     

医院战略性绩效评价指标体系研究

目的 基于医院战略,构建同医院战略相匹配的绩效评价指标体系。方法 运用Delphi法对绩效指标体系进行全面的筛选与整理,利用层次分析法来确定绩效指标体系的各级指标的权重。结果 设计出最能反映医院绩效的12个方面共50个指标,构建了以战略为导向的医院绩效评价指标体系。结论 基于医院战略的绩效评价,有利于提升医院核心竞争力,促进医院战略的实现。     

医院门诊自助服务系统使用率的多因素分析

目的 探索医院门诊一站式自助服务系统在不同干预措施下的使用情况和使用患者的反馈。方法 2015年1—12月通过对门诊进行未干预、3种单独干预各1月、两种较强联合干预和全线干预后,计算自助服务系统的使用人次和使用人次占比,之后对患者进行问卷随访,比较患者的满意度、机器正常运行率和节省的时间。结果 在入口处设置醒目标识提示自助服务系统,多途径宣传一站式服务并且在自助机旁配备充足的指导人员的自助服务系统使用率相对最高。结论 自助服务系统使用率的提升不仅需要多途径、多层次,还需要门诊管理者在必要的时机进行适当的策略调整以取得有效模式来配合门诊运转。

     

教学医院急诊日夜就诊病例分析

目的 探讨急诊就诊患者在不同时段的就诊规律,为急诊科管理提供依据。方法 收集门急诊就诊信息系统2009年10月1日—2010年4月30日急诊病例资料。采用多阶段随机抽样方法,共抽取7 634份急诊病例资料。结果 急诊患者中男性多于女性,急诊儿科中位年龄3岁,急诊内科、急诊外科中位年龄32岁。就诊科别以急诊儿科患者占多数。费用类别以自费患者为主。16：00—<00：00时上夜班为就诊高峰时段,在高峰时段,急诊儿科、医疗保险患者增加较明显,但疾病轻重分级以4级及5级轻症病例为主。结论 在就诊高峰时段,要相应调整排班,加强导诊和分诊,可缓解急诊科拥挤现象。学科建设中要加强急诊儿科医师的培养。     

实施“优质护理服务示范工程”的实践探讨

目的 探讨“优质护理服务示范工程”的实施及影响。方法 树立“优质护理服务示范工程”护理服务文化理念,制定“优质护理服务示范工程”护理服务标准及实施方法。结果 提高了病人满意度及护理工作质量、健康教育覆盖率及合格率,增进护患感情。结论 开展“优质护理服务示范工程”, 能提高护理质量, 确保护理安全,能扩大医院的知名度, 提升护理服务的品牌。     

名医素质特征与培养规律的初步研究

目的 探索名医的基本素质特征和培养规律。方法 在文献检索和专家访谈的基础上,采用自设问卷方式进行调查,并对调查结果数据进行统计分析。结果 知名医学专家与患者及家属在名医的内涵、培养目标、成长历程等问题上的观点是一致的,但在名医的培养周期、评价标准、培养方式等问题上存在着不同的观点。结论 名医不仅要拥有精湛的医术和高尚的医德,还要得到老百姓和医师同行的认可。名医的成才需要良好的成长环境和自由发展的空间,在成长的过程中我们可以通过发挥个人主观能动性,增强科室内部凝聚力,健全医师的考核体系,缓解紧张的医患关系,改革医学的教育模式等途径来培养名医。     

医疗纠纷院内鉴定制度在纠纷处理中的作用探讨

探讨在当今医疗纠纷频发的背景下,医院施行医疗纠纷院内专家鉴定制度的做法及效果。其有利于医院科学、客观地处理医疗纠纷,维护医患双方权益,促进医疗质量和医院管理水平的提高。

     

六种藓类植物茎的比较解剖学研究

通过对6种藓类植物,即褶叶青藓(Brachythecium salebrosum(Web.et Mohr.)B.S.G.)、湿地匐灯藓(Plagiomnium acutum(Lindb.)Kop.)、侧枝匐灯藓(Plagiomnium maximoviczii(Lindb.)Kop.)、大凤尾藓(Fissidensnobilis Griff.)、大羽藓(Thuidium cymbifolium(Doz.et Molk.)B.S.G.)和大灰藓(Hypnum plumaeforme Wils.)嫩茎和老茎的石蜡切片和显微观察发现,同一藓类植株的嫩茎和老茎,茎结构稳定,不同种藓类植物茎横切面具有不同特征.植物体茎横切面形状、表层细胞的层数、细胞大小和细胞壁厚薄、皮层细胞大小和形状、中轴的有无以及比例等特征可以作为藓类植物的分科分类依据之一.     

真菌类遗传学分析的知识结构教学

本文以认知结构理论为指导,讨论了真菌类遗传分析与高等动植物遗传分析的内在联系,认为利用这种内在联系进行教学可收到好的效果并说明了作者的具体教学过程。 Abstract:In the paper, the relationship between genetic analysis of Fungi and genetic analysis of high animal and plant was discussed.A good results were obtained when we adopted this method in the teaching.     

Cause of Senescence of Nine Sorts of Flowers

The levels of endogenous phytohormones and respiratory rate in nine sorts of flowers such as Cymbidium faberi Rolfe, Nopalxochia ackermannii Kunth and others were investigated both at full bloom and senescence and meanwhile the effect of exogenous phytohormones on prolonging the blossoms and promoting ethylene production were tested. There is a high content of endogenous ethylene in all the long-lived flowere, about 3–16 folds higer than the short-lived ones. There is a high level of ABA at full blooming flowers of short-lived flowers, in which there is no or only some cytokinins in it, but the ratio of CTK (6BA+zeatin)/ABA is smaller(l.7). The endogenous ABA reached a much higher level at senescence in all nine sorts of flowers, so it is reasonable to consider that it is ABA which plays an important role of regulation in controlling flower's senescence. There is a much higher level of GA3 and zeatin in the long-lived flowers which is not demonstrated in the shortlived ones. The respiratory rate is one of the factors controtling the longevity of flowers, but it does not play a decided role. Application of 6BA and zeatin prolongs distinctly orchid’s longevity, however exogenous IAA through the promotive action on ethylene production, evidently extends the longevity of the flowers of the Nopalxochia ackermannii Kunth.     

Time of detection of recessive genes: effects of system of mating and number of examined individuals

Summary Anthers were cultured from two sets of seven lines of hexaploid wheat (Triticum aestivum L.) with different cytoplasms, the euplasmic nucleus donors, Siete Cerros 66 and Penjamo 62, as well as their six alloplasmic lines derived from wild relative species of the genera Triticum and Aegilops. Significant cytoplasmic and nuclear effects but no cytoplasmic-nuclear interaction were found for embryogenic anther response, with the best performance of Penjamo 62 in Ae. kotschyi cytoplasm. Plant regeneration was not affected significantly by the cytoplasmic background of the lines cultured. The possible genetic implications of the observed cytoplasmic and nuclear influences on the in vitro haploid induction of wheat are discussed.     

龙胆科药用植物化学成分的研究现状

龙胆科植物在我国的分布范围很广,且多数为药用植物,其多数种属的药用植物,至今其化学成分尚未被系统研究。综述了目前龙胆科药用植物的化学成分的研究现状及一般提取方法,对近年来发现的环烯醚萜及裂环烯醚萜类化合物进行了总结,为本科药用植物的更深入研究提供了参考。     

Scales of spatial patterns of distribution of intertidal invertebrates

Few comparative studies of spatial patterns at different scales have examined several species in the same habitat or the same species over a range of habitats. Therefore, variability in patterns among species or among habitats has seldom been documented. This study quantifies spatial patterns of a suite of intertidal snails and a species of barnacle using a range of statistical techniques. Variability in densities was quantified from the scale of adjacent quadrats (over a distance of centimeters) to tens of kilometers. Significant differences in abundances occurred primarily at two spatial scales. Small-scale differences were found at the scales of centimeters or 1–2 m and, for many species on many shores, these accounted for most of the variability in abundances from place to place. These are likely to be determined by behavioural responses to small-scale patches of microhabitat. Large-scale differences in abundance were also found in most species at the scale of hundreds of meters alongshore. These are likely to be due to variation in recruitment (and/or mortality) because of limited dispersal by adults of these species. There was little or no additional variation among shores, separated by tens of kilometers, than was shown among patches of shore separated by hundreds of meters. Identification of the scale(s) at which significant differences in abundance are found focus attention on the processes (and the scales at which these processes operate) that influence patterns of distribution and abundance. Some of the advantages and disadvantages of various procedures are discussed.     

Identification of the site of glycation of human insulin

This study evaluates the nature of glycated human insulin formed following exposure to hyperglycemic conditions in vitro. Glycated insulin was purified by RP-HPLC and its molecular mass (5971.3 Da) determined by plasma desorption mass spectrometry (MS). The difference in mass (163.7 Da) from nonglycated insulin (5807.6 Da) corresponds to a single reduced glucose (glucitol) residue. Following reduction of insulin disulfide bridges, MS confirmed that the B-chain was glycated. Enzymatic digestions with trypsin, endoproteinase Glu-C, and thermolysin, followed by RP-HPLC and identification of fragments by MS, localized glycation to the B-chain (1–5) region. Electrospray tandem MS identified the site of glycation as the B-chain NH₂-terminal Phe¹ residue. This was confirmed by automated Edman degradation with glycated human insulin.