医院实施精细化管理的认识误区与对策

近几年国内医院精细化管理的实施取得了一些成绩,但是在追求科学管理的较高境界过程中,不断有新挑战、新要求、新促进和新变化,精细化管理走进了一系列误区。文章对医院精细化管理的内涵进行了阐述,剖析了医院实施精细化管理的认识误区,提出了科学实施精细化的建议,并列举实例讲解科学实施精细化管理的措施及取得的成效。     

Objectives and Metrics for Wildlife Monitoring

Abstract: Monitoring surveys allow managers to document system status and provide the quantitative basis for management decision-making, and large amounts of effort and funding are devoted to monitoring. Still, monitoring surveys often fall short of providing required information; inadequacies exist in survey designs, analyses procedures, or in the ability to integrate the information into an appropriate evaluation of management actions. We describe current uses of monitoring data, provide our perspective on the value and limitations of current approaches to monitoring, and set the stage for 3 papers that discuss current goals and implementation of monitoring programs. These papers were derived from presentations at a symposium at The Wildlife Society's 13th Annual Conference in Anchorage, Alaska, USA.     

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。     

“情绪管理”在临床护理管理工作中的应用体会

目的：探讨情绪管理在临床护理管理工作中的应用和效果,为临床护理管理的实践提供指导和帮助。方法：选取我院244名护士为研究对象,随机分为常规管理组和情绪管理组,每组各122名护士。常规管理组采取常规的护理管理模式,情绪管理组则对护士进行情绪调节、以适当方式释放压力等情绪管理方法。比较两组研究对象在解决问题、求助、合理化、退避、自责、幻想等方面的评分情况。结果：实施不同的管理措施后,情绪管理组护士在解决问题、求助、合理化、退避、自责、幻想等方面的得分结果明显优于常规管理组护士的得分结果,差异显著有统计学意义（P〈0．05）。结论：情绪管理对临床护理管理工作的实践具有重要意义,可有效调节护理人员的工作情绪,从而提高临床护理的质量。     

生态系统服务功能管理研究进展

生态系统给人类提供了自然资源和生存环境两个方面的多种服务功能,这些服务功能的可持续供给是经济社会可持续发展的基础.然而,生态系统服务功能从认知走向管理实践面临着严峻挑战,包括:定量测度、多种服务功能权衡、生态系统服务功能多尺度关联、生态系统服务功能与政策设计的结合.针对这些难点,近年来生态系统服务功能管理研究主要集中在以下领域:生态系统服务功能度量;生态系统服务功能与人类福祉的关系;多种生态系统服务功能权衡;生态系统服务功能保护规划;基于生态系统服务功能的生态补偿机制.为了进一步推动生态系统服务功能管理实践,应该进一步加强生态系统服务功能供给的理论研究;增加生态系统服务研究结果表达的多样性;增加与社会学、经济学、人口统计学等领域跨学科研究;进一步探索生态系统服务功能研究的结果如何运用到管理决策中,促进在管理实践中的应用.     

工作月报制在现代医疗管理中的应用与探索

“痕迹管理”是现代医院管理工作客观要求,北京大学第一医院建立了医疗管理工作月度报告制度,以《医疗管理工作日度报告》为载体,加强医疗管理处室内部组织以及医疗管理团队间的协作,提升了医院医疗管理水平。     

Best Practice Recommendations for Anesthetic Perioperative Care and Pain Management in Weight Loss Surgery

Objective: To develop evidence‐based recommendations that optimize the safety and efficacy of perioperative anesthetic care and pain management in weight loss surgery (WLS) patients. Research Methods and Procedures: This Task Group examined the scientific literature on anesthetic perioperative care and pain management published in MEDLINE from January 1994 to March 2004. We also reviewed additional data from other sources (e.g., book chapters). The search yielded 195 abstracts, of which 35 references were reviewed in detail. Task Group consensus was used to provide recommendations when evidence in the literature was insufficient. Results: We developed anesthesia practice and patient safety advisory recommendations for preoperative evaluation, intraoperative management, and postoperative care and pain management of WLS patients. We also provided suggestions related to medical error reduction and systems improvements, credentialing, and future research. Discussion: Obesity‐related comorbidities including obstructive sleep apnea place WLS patients at increased risk for complications perioperatively. Regarding perioperative safety and outcomes, conclusive evidence beyond the accepted standard of care in the reviewed literature is limited. Few reports specifically address the perioperative needs of severely obese patients. In this advisory, we synthesize current knowledge and make best practice recommendations for perioperative care and pain management in WLS patients. These recommendations require periodic review as further medical knowledge and evidence evolve.     

面向生态系统服务的森林生态系统经营:现状、挑战与展望

森林生态系统是地球陆地生态系统的主体,它具有很高的生物生产力和生物量以及丰富的生物多样性,对全球生态系统和人类经济社会发展起着至关重要和无可替代的作用。伴随着人口的不断增长和经济社会的迅猛发展,对森林资源和森林生态系统服务的需求不断高涨,而且人类对森林资源价值的认识也发生了很大程度的改变。推进森林资源可持续经营,增加森林总量、提高森林质量、增强生态功能,已成为中国林业可持续发展乃至推进中国生态文明建设和建设美丽中国的战略任务。本文全面综述了森林生态系统经营发展历程,分析了森林生态系统经营的现状和存在问题,在此基础上,提出整合基于生态系统管理与满足现代人类福祉对森林多重需求的新的森林生态系统经营理念,面向生态系统服务的森林生态系统经营理念是未来的发展趋势。森林经营发展战略表现为:1)从单纯的森林面积数量扩张,转变到提高单位面积的森林生产力和森林质量;2)从单一追求木材生产逐步转变为多目标经营,将森林林产品单一的经营目标转变为广泛的生态、经济和社会等多目标经营;3)森林经营重点从林分水平转变为森林景观的经营,强调森林景观的时空异质性和动态变化,权衡和协同多种生态系统的服务功能,倡导森林景观的多样性和连通性,提高森林与其它土地利用模式镶嵌构成的复合景观的可持续性和稳定性,增强森林生态系统对气候变化影响的适应能力;4)森林生态系统经营将从依赖传统经验的主观决策转变为信息化、数字化和智能化的决策,发展森林生态系统经营决策支持系统和森林景观恢复与空间经营规划系统。     

A framework for managing and monitoring bush regeneration programs: a case study from Lake Macquarie,NSW

It is widely recognised that effective bush regeneration and ecological restoration programmes must be well planned and require effective management and monitoring. While general guidelines for monitoring are available, few examples of effective site monitoring and reporting exist in practice. The note describes a framework developed for managing and monitoring a bush regeneration programme for coastal NSW and evaluates it against a set of principles for monitoring ecological restoration programmes. The example illustrates how tools could be developed to improve management and monitoring practice.     

实施干部岗位综合目标管理的实践与体会

目的 探讨在医院实施干部岗位综合目标管理,促进医院又好又快发展。方法 根据医院的目标任务,制定合理的干部岗位综合目标管理措施。结果 从2007—2009年实施干部岗位综合目标管理,效果显著,实现了预期的目标。结论 干部岗位综合目标管理是提升医院科学管理水平,增强医院竞争能力,促进医院社会效益和经济效益同步增长的有效措施。     

论医院绩效管理的人性化管理及其柔性化操作

医院绩效管理中存在倾向于刚性管理并热衷于惩罚方式的现象,其结果是无意中起了引导员工为逃避惩罚而隐瞒相关信息的作用,从而使医院员工不能共同分享与讨论各种经验教训,不利于医院进行持续质量改进。而有效预防与解决这一问题的主要策略是在绩效管理中进行人性化管理,并以柔性化操作处理那些不易进行刚性考核或易在刚性考核中产生消极后果的问题。     

Deslorelin acetate implant induces transient sterility and behavior changes in male olive baboon (Papio anubis): A case study

This case study evaluates the effects of a 4.7 mg deslorelin acetate implant on one male olive baboon (Papio anubis). Implantation induces transient azoospermia after which the subject was able to conceive again. Behavior was also impacted with a decrease in our proxies of aggressiveness and sexual arousal.     

棉花氮肥和水分运筹的动态知识模型

通过分析和提炼棉花氮肥运筹和水分管理的最新研究资料,在综合考虑气候条件、土壤理化性质、产量目标、品种特性等影响因子的基础上,根据养分平衡原理和水分需求规律,建立了棉花氮肥和水分运筹的动态知识模型．模型可用于精确定量不同环境和不同产量目标下的氮肥和水分需求总量及其在不同生育时期的分配比例等．利用不同生态点、不同品种、不同土壤类型和不同产量目标等资料对氮肥和水分运筹知识模型进行了验证．结果表明模型具有较好的决策性和适应性．     

Conservation and management issues of Prespa National Park

The present article describes the human activities inthe area and their changes and trends, given that thecontemporary nature conservation key issues areclosely related to past and present socio-economic andcultural conditions, both within Prespa itself andoutside of it. The liberation of Prespa, a remote andrather socially isolated borderline area, from Ottoman occupation took place in 1912–13. Recentevents in its environmental history have been forestclearings and human depopulation in the Civil War(1944–49), irrigation system construction in the1960s, its discovery by ornithologists in the late1960s, the high emigration rates of 1960–1980, itsdesignation as a National Park in 1974, thedestructive development works of 1984–86 afterGreeces entry to the EEC and the conversion to intensivebean cultivation in the mid 1980s.The human population of ca 7000 at the start of thiscentury suffered an almost 80% decrease after theCivil War. A resettlement in the mid 1950s increasedthe population by 40% but in the 1970s emigrationreduced it to its previous size of around 1500, stillits present size. The extensive and diverse farmingsystems of previous centuries changed gradually afterthe construction of an irrigation network in the1960s, which twenty years later and along withinternational changes in production and economypatterns, made possible the present day domination ofa bean monoculture within irrigated croplands. Thiswas accompanied by increased energy inputs,mechanisation and the use of chemicals.Intensification of agriculture brought increasedincomes which attracted also livestock keepers,resulting in a 56% decrease in numbers of livestockin 1964–1993. Cattle are presently kept for meatproduction only. They graze on the mountains, and nolonger in the meadows around the lakeshore. A localshorthorn breed accounting for 93% of all cattle in1963 declined to less than 18% in 1993. Fishing aimedmainly at carp and Prespa bleak, continues today as inthe past to be a source of supplementary income.Eighty-six per cent of the – mainly oak and beech –forests are State owned and the rest belong to localmunicipalities. The forest area has not changedessentially in the last 40 years, but forest roadshave expanded. Forests provide mainly fuelwood forlocal needs and small quantities of industrial timber.No specific management is conducted to safeguard theconservation values of the forest, the majority ofwhich consists of even aged coppiced stands withlimited value for wildlife. Manufacturing never playedan important role for the economy of the area. Tourismhas increased in the last 20 years, concentratedmainly in summer and spring. Accommodation in thevillages is not yet satisfactory though it hasimproved enormously in recent years. The NationalParks infrastructure for visitors remains poor.Tourist pressure generally is not yet that high toimpact drastically the social and environmentalfabric. In places, hunting, angling and poaching cannegatively affect the target species. The constructionof the irrigation network in the eastern part of LakeMikri Prespa was the most important change to thelandscape and the habitats of Prespa the last 30years. It resulted in the embankment of free-flowingstreams, drainage of wet meadows and dramaticreduction of trees and hedges. In the last 15 years,the reedbeds, no longer burnt or mowed and assisted byincreased nutrient loadings from agricultural runoff,have expanded landward to occupy formerly open,periodically flooded, areas. The above changes inhabitats and land use have brought an impoverishmentof biodiversity which can be seen in the exterminationor the decrease in the numbers of certain plant andbird species.The problems preventing a better management of theNational Park and the perpetuation of its values areinappropriate legislation, the poor degree ofcoordination of the public services, the lack of botha specific National Park Service in Greece and amanagement authority for the Park and the hostileattitude of local people due to their limitedinformation and involvement. The scenic beauty, thewetlands and a number of rare habitats, the diversityof habitats, flora and fauna, the endemic life forms,the rare mammals and the colonial waterbirds, thelocal architecture and the cultural expressions suchas the Byzantine monuments, are the values of Prespathat must be preserved as a whole. The initialconservation efforts aimed at preserving biodiversitybut later it became apparent that not only are humansan inseparable part of the whole, but additionally,several of their extensive activities have contributedsubstantially to the rich biodiversity of the area.Through the prerequisites of keeping a balance betweenprimary and tertiary sector activities and ofrevitalizing the social fabric, the following are thekey management and conservation issues of today: anunequivocal agreement on the values to be preservedand their limits; the formation of a managementauthority; a new realistic protection and land usezoning; the diversification and extensification of allfarming activities; the restoration of the wet meadowhabitats; the ensuring of a high water level and agood water quality for both lakes through tri-lateralcooperation between Greece, Albania and FYROM; and theestablishment of a permanent environmental monitoringscheme.     

哈尔滨市综合医院手术室病人安全管理现状与对策研究

采用随机抽样的方法,在哈尔滨市随机抽取5家三级、5家二级综合医院的手术室进行病人安全管理现状调查。从手术室护理人员构成、人员培训、规制、布局流程、设备配置、病人辨识、消毒灭菌、医护配合8个方面全面分析了目标医院在手术室病人安全管理方面存在的问题,并提出改进对策,旨在改善手术室管理现状,保障手术室病人安全。     

Twelve years on: Ecological restoration and rehabilitation at Sydney Olympic Park

When Sydney's 760 ha Homebush Bay industrial site was rezoned for urban renewal and staging the Olympic Games in 2000, massive investment was made to remediate past damage and develop a future public park containing active recreation and natural areas. Since that date, endangered forest and wetland communities, along with threatened fauna species, have received priority treatments to improve the ecological function of the Park's natural areas. Evaluation of progress 12 years on reveals substantial achievements and multiple lessons.     

中国人工林经营发展战略与对策:从追求木材产量的单一目标经营转向提升生态系统服务质量和效益的多目标经营

人工林是全球森林资源的重要组成部分,在木材生产、环境改善、景观建设和减缓气候变化等方面扮演着愈来愈重要的角色。尽管我国人工林面积和蓄积不断增长,但是,人工林存在质量较差、结构不尽合理、生产力不高、生态功能较弱和生态稳定性下降等问题。人工林生态系统服务功能难以满足经济社会日益增长和新时期人们对美好生活向往的多方面需求。面对未来人工林面积继续增加受到适宜发展空间的严重制约和气候变化带来的现实和潜在的影响,亟需改变和调整我国人工林经营的发展战略和对策,将从人工林面积扩张、蓄积增加转变为人工林生态系统服务的质量和效益提升。如何提高人工林生态系统服务的质量和效益,创建健康稳定、高生产力和高碳汇的人工林生态系统,既能提供高产优质木材,又能够发挥固碳减排、生物多样性保护、水源涵养和水土保持等多种生态功能,以满足经济社会发展对森林的多种新需求和林业应对气候变化的新任务,亟需探索适合我国新时期人工林生态系统可持续经营的理论和多目标经营范式。在深入分析国际和我国人工林发展历程、变化趋势、面临问题的基础上,充分汲取和借鉴国际人工林经营的理念、经验和实践成果,并结合我国现阶段人工林发展实际情况,探索人工林生态系统服务质量与效益提升的发展思路和实践途径,从多层次、多尺度定位面向生态系统服务的人工林经营对策,倡导并实施人工林生态系统适应性经营,实现人工林生态系统服务的多目标权衡与协同,为我国人工林经营的战略转变和对策创新提供决策参考与未来展望。     

Booderee National Park Management: Connecting science and management

A 10‐year science–management partnership has focussed on three key issues within Booderee National Park in eastern Australia: the impacts of fire on native biota, the response of vertebrates to feral animal control and the control of Bitou Bush. What has been achieved to date and what are the partnership's key ingredients?     

Revisiting the ichthyodiversity of Java and Bali through DNA barcodes: taxonomic coverage,identification accuracy,cryptic diversity and identification of exotic species

Among the 899 species of freshwater fishes reported from Sundaland biodiversity hotspot, nearly 50% are endemics. The functional integrity of aquatic ecosystems is currently jeopardized by human activities, and landscape conversion led to the decline of fish populations in several part of Sundaland, particularly in Java. The inventory of the Javanese ichthyofauna has been discontinuous, and the taxonomic knowledge is scattered in the literature. This study provides a DNA barcode reference library for the inland fishes of Java and Bali with the aim to streamline the inventory of fishes in this part of Sundaland. Owing to the lack of available checklist for estimating the taxonomic coverage of this study, a checklist was compiled based on online catalogues. A total of 95 sites were visited, and a library including 1046 DNA barcodes for 159 species was assembled. Nearest neighbour distance was 28‐fold higher than maximum intraspecific distance on average, and a DNA barcoding gap was observed. The list of species with DNA barcodes displayed large discrepancies with the checklist compiled here as only 36% (i.e. 77 species) and 60% (i.e. 24 species) of the known species were sampled in Java and Bali, respectively. This result was contrasted by a high number of new occurrences and the ceiling of the accumulation curves for both species and genera. These results highlight the poor taxonomic knowledge of this ichthyofauna, and the apparent discrepancy between present and historical occurrence data is to be attributed to species extirpations, synonymy and misidentifications in previous studies.