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。     

提升我国日间手术管理水平的思考与建议

分析了我国日间手术的现状、存在的问题,从建立高效顺畅的日间手术服务流程、确保日间手术质与量的平衡发展、完善日间手术医疗服务链、建立日间手术评价体系、完善日间手术医保支付方式以及开展日间手术能力审核六个方面,为提升我国日间手术管理水平提供建议。     

非计划再次手术关键环节管理与效果分析

目的 探索有效降低非计划再次手术发生率的管理方法。方法 对2012年1月—2016年12月住院并进行手术的患者进行主动监测,加强管理,发现非计划再次手术病例,统计发生率及引发原因。结果 225 944例手术共发生非计划再次手术914例,平均发生率为0.40%且五年呈显著下降趋势。引发原因以手术部位感染、切口裂开、切口疝或愈合不良,术后出血,出现漏或瘘为主,共占73.9%。结论 完善主动监测与报告系统、加强院科两级管理、注重原因分析与改进可有效降低非计划再次手术的发生率。     

Flyway population delineation in Taiga Bean Geese Anser fabalis fabalis revealed by multi‐element feather stable isotope analysis

Fundamental to effective management of migratory waterbird populations is an understanding of their flyway delineation. Taiga Bean Geese Anser fabalis fabalis wintering in NW Denmark, Scotland and England are considered to originate from northern and central Sweden, southern and central Norway (‘Western flyway’), those wintering in southern Sweden, NE and southern Denmark are considered to originate from northern Fennoscandia and western Russia (‘Central flyway’), and those wintering in eastern Germany and Poland (which show far less favourable conservation status) are thought to come from western Siberia (‘Eastern 1 flyway’), although evidence to demonstrate this has largely been lacking. Evidence for different natal and moult origins of Taiga Bean Geese was investigated using stable isotope analyses of feathers of four elements (δ²H, δ¹³C, δ¹⁵N and δ³⁴S). There were significant differences in isotopic composition of feathers from Swedish (Central) and German (Eastern 1) wintering populations and those moulting in Sweden in late summer (Western), which validated the three proposed major management flyway units above. The strong continental gradient in the stable hydrogen isotope ratios in precipitation (δ²H_p) across the region was used to assign wintering birds geospatially to natal and moulting origin, indicating separate natal and moulting areas for German (n = 37, from western Siberia) and Swedish (n = 20, Fennoscandia and more western Russia) wintering birds. These results confirm the largely discrete nature of these three flyways and contribute significantly to our ability to deliver effective targeted and appropriate research, monitoring and management actions throughout the ranges of these flyways.