吉林省荣军医院医护人员配置现状调查

目的 研究吉林省荣军医院医护人员资源配置现状。方法 采用自行设计的荣军医院医护人员配置情况调查问卷,对吉林省荣军医院开展调查研究。结果 被调查荣军医院医护比例为1：0.26,床护比例为1：0.03,荣复军人床护比为1：0.05;医生年龄主要集中在36～44岁之间,而护士年龄主要集中在45岁以上;护士学历结构集中在中专及以下层次。结论 被调查医院医护人员配置不足、学历层次偏低,难以满足荣复军人的需求,应进一步加强荣军医院的人员配置,提高人员综合素质。     

临床路径在老年性白内障手术患者中的应用评价

目的 探讨临床路径在老年性白内障手术患者中的应用及实施效果。方法 选取2009年6月—2012年6月期间在某三甲医院住院手术治疗的3 758 例老年性白内障病人为研究对象,采用对照研究,经患者同意,将其分为对照组（1 995例）和观察组（1 764例）,比较两组平均住院日、平均住院费用、西药费用、辅助诊断费、患者满意度、健康知识知晓程度。结果 观察组的平均住院日、平均住院费用、西药费用、辅助诊断费、并发症发生率均低于对照组（P <0.000 1）, 患者满意度及健康知识掌握情况均高于对照组（P<0.05）,差别具有统计学意义。结论 临床路径应用于白内障手术,可以缩短住院天数,降低医疗费用及辅助诊断费,提高患者的满意度,提高患者对健康知识的掌握率,减少术后并发症的发生。     

老年性白内障患者住院费用及相关因素的现况调查

目的 探讨老年性白内障住院患者住院费用的年龄、性别和不同医院的分布特点,为提供科学收费标准提供参考依据。方法 采用整群抽样的方法对2009年不同医院9 464例老年性白内障患者的住院费用及相关因素进行横断面调查并进行初步分析。结果 将老年白内障患者按<60岁、60~80岁、>80岁分为3组,床位费、西药费、检验费、放射费、特检费、治疗费、手术费和护理费均随年龄增加而增加且存在统计学差异。以上费用,男性患者均高于女性且存在统计学差异。海军医院患者最高（P<0.05）,其他由高至低依次为全军陆军医院、全军空军医院和全军二炮医院患者。结论 卫生决策部门应针对其不同特点制定适宜收费标准,有必要跟进研究不同病种费用区别的制度或管理层面的原因。

     

流行病与卫生统计学人才在科室发展中的需求分析

旨在探讨流行病与统计学人才在医院科室管理中的价值与需求。对北京大学肿瘤医院共计218人进行问卷调查,研究对象包括来自16个科室的临床医生85人,技师/护士97人,行政管理人员36人。调查结果显示：77.06%的调查对象认为非常需要流行病与卫生统计学人才,62.84%的调查对象认为应该在科室内部单独设置此岗位。1年内,临床科室医生平均求助10.0次,接近非主系列的6倍。研究表明,医院科室对于流行病学与卫生统计学人才有一定的需求,临床科室医生对于该专业人才需求度较高。     

对临床输血病案文书质量的调查与分析

目的 探讨临床输血病案文书的内涵质量。方法 采取随机抽查的方法对某院2009—2010年已经归档的输血病案,按卫生部“医院管理年和医疗质量万里行”活动内容进行调查。结果 发现多份病历不合格。结论 临床输血病案文书是临床医师对患者治疗过程的原始记录,是当时事态的真迹,是医疗事故或纠纷在认定是非、判明责任,以及医疗技术鉴定或司法鉴定时赖以立论的依据。因此,写好病案文书可减少医疗纠纷的发生。     

持续改进围术期预防性抗菌药物不合理使用成效分析

?????? 目的 分析围术期预防性抗菌药物使用中不合理使用的原因,并采取相应的干预对策。方法 2005年以来定期调查围术期抗菌药物预防使用状况,根据调查和反馈的结果不断改进干预措施。积极使用计算机网络和HIS的后台管理进行干预,同时将查出问题反馈给手术医生等一系列干预措施。结果 通过连年的综合干预,围术期抗菌药物带入手术室使用率从51.19%上升到97.33%,围术期预防性抗菌药物使用品种合格率从25.03%上升到79.68%,围术期预防性抗菌药物使用平均天数I类手术从5.49天下降到1.72天,II类手术从6.29下降到3.79天。结论 多部门联动、综合干预、持续改进是取得成效的关键。     

患方对医院投诉管理的认知和诉求分析

目的 了解患方对医院投诉管理的认知和诉求状况,为制定医院投诉管理规范提供参考。方法 采用现场问卷调查的方法对4家医院的200名患者进行调查并对结果进行统计分析。结果 患方对医院投诉的知晓度有限;患方对完善投诉管理的重要性认同度较高;患方对系统规范化的投诉处理机制有强烈诉求;患方对医院投诉管理的现状并不满意。结论和建议 高度重视医疗投诉,加大对医疗投诉的宣传力度;完善投诉渠道,塑造缓和医患矛盾的内外部环境;建立投诉处理反馈机制,加强对投诉信息的有效利用。     

医院行政管理人员培训需求的调查研究

目的 明确医院行政管理队伍培训需求,为建立规范化培训体系,提高医院管理水平奠定基础。方法 采用问卷调查法,面向医院行政管理人员开展个人培训需求意愿、医院内部管理体系运行现状及个人岗位胜任能力调查,在此基础上进行组织、岗位及个人层面的培训需求分析。结果 医院行政管理人员接受培训的意愿较为突出,而不同层级之间对培训内容、时间及方式的需求存在明显差异。结论 医院行政管理人员具有较为强烈的培训需求,建立一套科学实用的长效培训机制是建设高素质医院管理队伍的基础性工程。     

河北省精神科护士应对精神科暴力技能培训的调查研究

目的 了解河北省精神科护士应对精神科暴力行为技能培训情况,为做好精神科护士防暴技能培训提供依据。方法 采用自制调查问卷,对河北省精神科护士防暴技能培训情况进行调查分析。结果 （1）48.1%的护士回答经常和常常经历精神病人的暴力行为,并且有93.8%的护士在处理暴力行为时受到过不同程度的伤害;（2）15.2%和33.7%的护士对自身的职业安全没有关注和很少关注,92.5%的护士认为各级管理者对护士的职业安全未引起足够的重视;（3）应对暴力专业技巧（脱身法、控制法）的培训情况,75.6%的护士回答没有或很少有;（4）96.5%的护士回答需求或非常需求精神科暴力行为的专业技巧培训。结论 河北省精神科临床暴力行为普遍存在,暴力行为对护士造成不同程度的伤害,但对精神科护士防暴专业知识和专业技能技巧培训非常欠缺,远远达不到护士的需求,所以要提高各级领导和护士自身对精神科护理职业安全的关注和重视,加大对精神科护士防暴知识和技巧的培训,减少精神科暴力行为的伤害。     

手术室流程优化后连台手术间隔时间的研究

目的 通过比较研究Ⅱ级手术间不同空气洁净时间,得出连台手术理想的间隔时间。方法 选择Ⅱ级手术间第一台手术结束后进行清洁净化,在清洁前和净化后15 min、30 min、45 min的3个时间段采用平板暴露法进行沉降菌监测。结果 清洁前沉降菌数超过标准,而清洁15 min后沉降菌数已降到标准要求。分别对培养皿清洁前、清洁后
15 min、30 min、45 min间进行方差分析,结果显示有统计学意义（P<0.01）;经多重比较（LSD）,清洁后15 min、30 min、45 min与清洁前比较,差异均有统计学意义（、P<0.01）,而清洁15 min后各时间点比较,差异无统计学意义（P>0.05）。结论 手术结束后手术间净化15 min即可进行连台手术。     

基于老年人口卫生服务分析的医保效果评价

目的 通过对某省老年人口卫生服务需求、利用、就医流向及费用负担等卫生服务指标进行测算,了解现行医保制度的实施效果。方法 通过抽取某省第五次卫生服务调查的老年人群数据,对社会人口学特征、卫生服务需求与利用、医疗卫生费用负担及住院流向等指标进行测算与分析。结果 不同医保制度下,老年人口卫生服务需求与利用存在差异性,且在住院就医服务的选择上尚未形成合理格局,卫生费用负担较重。结论 某省现行医保制度对老年人口的经济保护力度仍有待提高,应调整医保制度卫生福利包的覆盖范围并提高补偿水平,通过政策倾斜构建合理就医格局,进而减轻老年人口的疾病经济负担。     

国内7省市老年人抑郁症的检出率及影响因素分析

目的:调查分析国内7省市老年人抑郁症的检出率及特点,并从老年人基本情况、躯体健康、认知功能等方面综合分析抑郁症的影响因素。方法:采用GDS-30量表分析2011-2012年在北京、上海、哈尔滨、西安、成都、长沙和重庆市及周边乡镇的9200名60岁以上老年抑郁症的发生情况,并分析影响抑郁检出率的相关因素。结果:调查老年对象的抑郁症检出率为17.2%,其中男性为15%,女性为19.6%。女性老年人在各个年龄段的抑郁症检出率均高于男性。抑郁症检出率随着年龄的增加逐渐增加。文化水平、健康自评、认知功能与抑郁症检出率密切相关。结论:抑郁症是国内7省市老年人常见的心理疾病,女性、高龄、低文化水平、健康自评差、认知功能障碍的老年人患抑郁症的几率更高。     

Patient Preferences Regarding Device Reuse and Potential of Devices for Reuse - A Study in a Veteran Population

BackgroundMany cardiac patients need and undergo device implants. Veterans’ preferences regarding post-mortem handling of devices are not known. Cardiac patients in low- and middle-income countries who need but cannot afford devices rely on donations. Charitable organizations have successfully provided devices for reuse to such patients.ObjectiveWe estimated the number of devices with potential for possible reuse in a veteran population.MethodsBetween January and December 2008, at a tertiary medical center, veterans with implanted cardiac devices were surveyed using a questionnaire for their preferences regarding post-mortem handling. One choice was donation to charity for reuse. Although altruistic, it is unclear what percent of such devices have reuse potential. Retrospective chart review of veterans who underwent device implants between 1992 and 2007 identified a cohort of patients with Implantable Cardiac Defibrillators (ICDs) who had died by April 31st 2009. In this cohort, ICDs implanted in the year preceding the patient’s death were counted as having reuse potential.Results94 of 97 veterans completed the survey. 56% were unaware of how devices are handled after death. The top three preferences for postmortem handling were: return to manufacturer, return to hospital and donation for reuse. 88% were willing to sign an advance device directive. Retrospective review identified 161 veterans who had received 301 ICDs. Of these, 77 ICDs (25%) had median reuse potential of 3.1 years.ConclusionIn a VA cohort of deceased patients a substantial proportion of devices had reuse potential. Further research is needed to direct health policy.     

Attitudes to and knowledge about oral health care among nursing home personnel--an area in need of improvement

doi: 10.1111/j.1741‐2358.2011.00562.x
Attitudes to and knowledge about oral health care among nursing home personnel – an area in need of improvement Background: In 1999, a dental reform became law in Sweden that regulated both dental care to dependent individuals and training in oral health care for nursing home personnel. Substantial resources have been channelled into these efforts, but the outcome of these efforts has not been evaluated. The aim of this study was to explore attitudes to and knowledge about oral health care among nursing home personnel more than 5 years after the law was adopted, that being 2005. Methods: A total of 454 individuals employed at nursing homes answered a questionnaire of 16 multiple‐choice items concerning attitudes to and knowledge about oral health care. Results: Eighty‐nine per cent considered oral health care to be an important part of good nursing. The answers indicated problems, however, when it came to its implementation and knowledge, and 35% stated that they had had no formal education in oral health care. Conclusions: Despite generally positive oral health care attitudes, it is important that oral health care education is available to and made of interest for all nursing home personnel, especially in light of the increase in number of natural teeth and frequency of crowns and bridges among dependent elderly.     

广西壮族自治区县级医疗卫生资源配置的公平性研究

目的 对广西县级医疗卫生资源配置的公平性进行分析。方法 采用洛伦茨曲线和基尼系数等方法,从人口和地理分布对广西91个县域医疗卫生资源(床位、卫生技术人员、医生)的配置公平性进行分析。结果 广西县级医疗卫生资源中床位、卫生技术人员、医生按人口分布的基尼系数分别为0.230 3、0.239 6、0.250 4,按地理分布的基尼系数分别为0.346 1、0.353 4、
0.352 3。结论 广西县级医疗卫生资源配置的公平性较好,其中人口分布优于地理分布,床位分布优于卫生人力资源分布。广西县级医疗卫生资源配置的公平性低于广西总体水平,但优于城区医疗卫生资源的配置。应进一步加大县级医疗卫生资源的投入,不断缩小城乡差距,提高县级医疗卫生资源在人口和地理配置的公平性。     

上海市患儿家长健康教育需求及现状调查

??????? 目的 了解上海市患儿家长对健康教育知识和方式的需求情况,提出做好患儿家长健康教育的方法和途径。方法 在文献检索和专家咨询的基础上,采用自行设计的调查问卷对200名门诊患儿家长和300名住院患儿家长进行调查,并对调查结果进行统计分析。结果 患儿家长对健康教育知识的需求广泛,教育方式的需求多样,对目前开展的健康教育,住院患儿家长的满意度要好于门诊患儿家长,但仍存在一定的不足。 结论 通过满足患儿家长对健康知识的需求、丰富健康教育的形式、加强医护人员人文教育等途径来做好患儿家长的健康教育。     

Role of vaccinations as risk factors for ill health in veterans of the Gulf war: cross sectional study

ObjectivesTo explore the relation between ill health after the Gulf war and vaccines received before or during the conflict. To test the hypothesis that such ill health is limited to military personnel who received multiple vaccines during deployment and that pesticide use modifies any effect.DesignCross sectional study of Gulf war veterans followed for six to eight years after deployment.Setting UK armed forces.ParticipantsMilitary personnel who served in the Gulf and who still had their vaccine records.Results The response rate for the original survey was 70.4% (n=3284). Of these, 28% (923) had vaccine records. Receipt of multiple vaccines before deployment was associated with only one of the six health outcomes (post-traumatic stress reaction). By contrast five of the six outcomes (all but post-traumatic stress reaction) were associated with multiple vaccines received during deployment. The strongest association was for the multisymptom illness (odds ratio 5.0; 95% confidence interval 2.5 to 9.8).ConclusionAmong veterans of the Gulf war there is a specific relation between multiple vaccinations given during deployment and later ill health. Multiple vaccinations in themselves do not seem to be harmful but combined with the “stress” of deployment they may be associated with adverse health outcomes. These results imply that every effort should be made to maintain routine vaccines during peacetime.     

TMD and GOHAI indices of Brazilian institutionalised and community-dwelling elderly

Rationale and objectives: Considering the controversy in the literature regarding several aspects of temporomandibular dysfunction (TMD) in elderly populations and the absence of reliable data on elderly Brazilians in this field, this study consisted of an evaluation of TMD prevalence and the self‐perception of oral health among institutionalised and community‐dwelling elderly in São José dos Campos, Brazil. Methods: Two hundred and fifteen community‐dwelling and 185 institutionalised elderly people were evaluated by the Helkimo anamnestic (Ai) and clinical dysfunction (Di) indices and answered a questionnaire using the Geriatric Oral Health Assessment Index (GOHAI). Results: The major prevalence of TMD symptoms was for the Ai0 (symptom‐free) group (69.5%), while the major prevalence of clinical signs was for the DiI (mild) group (56%). Women presented a higher AiII classification than men (χ² test, p = 0.049). Community‐dwelling elderly presented a significantly lower Ai0 classification than the institutionalised ones (Two ratios equality test, p < 0.001). There was no relationship between the institutionalised status and the clinical dysfunction index for Di0 and DiIII classification (Two ratios equality test, p = 0.194 and 0.535 respectively). The institutionalised elderly presented greater (One‐way anova = 0.005) self‐perception of oral health (33.45) than did the community‐dwelling group (32.66). There were only weak Pearson’s correlations among the anamnestic (?33.0%) or clinical (?14.7%) findings by the TMD and GOHAI indices. Symptom‐free (Ai0) institutionalised elderly presented better scores in all GOHAI dimensions and elderly representing an absence of clinical TMD signs (Di0) presented higher GOHAI physical dimension scores in both groups. Conclusions: The prevalence of TMD symptoms among this sample of elderly individuals was relatively low, self‐perception of oral health was reasonable and a weak, inverse correlation was found between TMD signs and symptoms and elderly self‐perception of oral health measured by the GOHAI index.