我国公立医院提升文化力路径探究

通过对公立医院文化力缺失的原因及其重要性的分析,提出公立医院提升文化力的路径。以文化力的提升形成医院的文化合力,并籍此来化解医患矛盾,创造和谐医患关系,树立医院文化形象,提升医院核心竞争力。     

县级医院医务人员稳定性与影响因素实证研究

目的 分析县级医院医务人员的稳定性以及影响因素,以促进县级医院人才队伍的稳定性建设。方法 通过对我国4个省12家县级医院的在职医务人员进行现场调查,运用描述性与卡方检验的方法进行统计学分析。结果 有51.9%的县级医院医务人员都表示曾经想过离开本单位,而且高层次人才具有较高的离职倾向。工作条件中的业务活动经费不足和加班太多,以及工作困扰中的没有合作团队、工作不受重视和人际关系不和谐会显著影响县级医院医务人员的稳定性。结论 通过各种途径稳定人才队伍是县级医院得到长效发展的关键。     

救治人员总协调制度在严重多发伤早期救治中的作用

目的 探讨院内救治人员总协调制度对严重多发伤早期救治的作用,以进一步优化创伤病患救治流程。方法 选取2013—2014年在苏州市立医院救治的严重多发伤病人共130例为研究组,同时回顾2011—2012年苏州市立医院救治的严重多发伤病人共123例为对照组,比较研究组与对照组在院内术前时间、在院监护时间、早期漏诊率、早期死亡率及并发症发生率等指标的变化。结果 研究组病人的院内术前时间、在院监护时间较对照组显著缩短,早期漏诊率、早期死亡率和并发症发生率均显著降低。结论 院内救治人员总协调制度的执行可有效提高严重多发伤早期救治效率。     

Homelessness and dog ownership: an investigation into animal empathy,attachment, crime,drug use,health and public opinion

Abstract

A sample of 51 homeless people in Cambridge, UK completed a questionnaire featuring adapted Animal Empathy and Companion Animal Bonding Scales. Concepts of crime, drug use, and health matters amongst the homeless, both dog owning and non-dog owning, were investigated, as well. Ninety members of the general public completed a similar questionnaire which sought their opinions on homeless people who own dogs. There was a highly significant difference (p < 0.01) between the homeless and the securely housed on their animal empathy and attachment scores, with the homeless sample displaying higher values. Gender and dog ownership status had no effect on these scores. A near significant result (U = 2, n₁ = 13, n₂ = 58, p = 0.06) was revealed for animal empathy scores of those who gave money to dog-owning homeless people and those who gave to non-dog owning homeless people. Of the public respondents, women were significantly more likely to show concern for a homeless person's dog's welfare than men (X²₍₁₎ = 8.5, p < 0.01), and of the homeless respondents, non-dog owners were significantly more likely than dog owners to believe that having a dog helped initiate conversations with the public (X²₍₁₎ = 4.0, p < 0.05). Highly significant differences (U = 10, n₁ = 31, n₂ = 20, p < 0.01) were found for medical care use between the dog-owning and non-dog owning homeless, and health scores showed a reversed trend compared to that expected for the general population, with dog owners scoring lower than non-dog owners.     

专项整治对综合医院抗菌药物使用强度的影响

??????? 目的 探讨抗菌药物临床应用专项整治活动对综合医院住院患者抗菌药物使用强度的影响。方法 以限定日剂量（DDD）为单位,对某综合性医院在实施专项整治前、后住院患者抗菌药物使用强度（AUD）进行统计、分析。结果 专项整治活动降低了住院患者累计AUD值,大环内酯类等药物AUD明显下降,第二代、第三代和第四代头孢菌素和不同管理级别抗菌药物AUD均下降。但还存在用药集中、注射用头孢哌酮钠舒巴坦钠AUD下降不明显等问题。结论 专项整治有效降低了综合医院住院患者AUD,但与卫生行政部门标准仍存在差距,应进一步加强管理。     

Exploiting the Potential of Public Procurement: Opportunities for Circular Economy

The objective of a circular economy (CE) is to maintain the value of products, materials, and resources in the economy by closing material loops and minimizing waste generation. In recent years, the role of public procurement has been recognized as an important, but as yet not fully exploited, opportunity by cities and municipalities in their transition toward circular societies. This study analyzed public procurement opportunities to promote CE. Different approaches and examples of circular public procurement were identified using case studies. In addition, opportunities to promote CE through sustainable and green public procurement policy were identified analyzing predefined sustainable or green public procurement criteria. The study concludes that public procurement can promote CE and related business models by setting criteria and requirements for the extension of product life spans, efficiency and/or intensity of use, and efficient cycling of biological or technical materials, as well as for the securing of clean and nonrisky cycles. Circular procurement can occur through the procurement of better‐quality products in circular terms, the procurement of new circular products, the use of business concepts that support the CE, and investments in circular ecosystems. Several sectors and product groups were identified as having potential for circular procurement, such as construction, waste, and wastewater management, transportation, food, and catering, furniture, and textiles. The study also suggests that the use of certain tools, such as performance‐based procurement, life cycle approach, and life cycle costing, as well as criteria concerning reuse and recycling of materials, could promote circular procurement. Market dialogue and cooperation between procurers and actors in the supply chains are important for the future development of circular procurement.     

加强多院区大型医院门诊工作的实践与探讨

针对医院门诊工作现状,扩大项目、夯实基础、细化流程、建立机制,实现多院区医院门诊工作专家及专病专业化、各院区门诊资源均衡化、门诊诊疗模式多样化、门诊服务流程标准精细化、门诊诊疗全程信息化、社会不同人群及层次门诊服务需求特需化。     

Surveillance of antibiotic resistance

Surveillance involves the collection and analysis of data for the detection and monitoring of threats to public health. Surveillance should also inform as to the epidemiology of the threat and its burden in the population. A further key component of surveillance is the timely feedback of data to stakeholders with a view to generating action aimed at reducing or preventing the public health threat being monitored. Surveillance of antibiotic resistance involves the collection of antibiotic susceptibility test results undertaken by microbiology laboratories on bacteria isolated from clinical samples sent for investigation. Correlation of these data with demographic and clinical data for the patient populations from whom the pathogens were isolated gives insight into the underlying epidemiology and facilitates the formulation of rational interventions aimed at reducing the burden of resistance. This article describes a range of surveillance activities that have been undertaken in the UK over a number of years, together with current interventions being implemented. These activities are not only of national importance but form part of the international response to the global threat posed by antibiotic resistance.     

医院大数据应用影响因素分析与对策研究

目的 深入分析限制医院大数据应用普及的影响因素,研究促进医院大数据应用的对策与方法。方法 采用德尔菲法自制医院大数据应用影响因素调查问卷,随机抽取中国研究型医院学会医疗分会64家会员单位会员代表进行调查,获得有效问卷104份,有效回收率为94.55%。结果 应用推广（4.14±0.65）分,管理方式（4.07±0.60）分,数据基础（3.88±0.82）分。不同性别、年龄、职称、岗位组间对于影响因素的态度差异没有统计学意义（P > 0.05）。多元线性回归分析结果显示,管理方式（b= -0.381, P=0.019）和“缺乏大数据专业化人才”（b=-0.268, P=0.011）会对医院大数据应用普及程度产生显著的负向影响关系。结论 医院大数据应用水平未能有效满足医务人员需求,应从管理顶层设计入手,重点加强大数据专业化人才的培养,同时注重提升数据基础质量和应用推广力度。     

基于FMEA的C形臂X线机的使用风险分析与控制

??????? 目的 基于失效模式与效应分析（FMEA）方法分析控制C形臂X线机的使用风险。方法 成立FMEA 5人小组,运用现场观察和访谈的方法,识别C形臂X线机使用的潜在失效模式,并对其发生的严重度、发生概率及检测的难易度进行评价打分,计算失效原因的风险优先指数。结果 FMEA小组找出了必须优先解决的C臂机使用的失效模式,制定并实施了改进措施,在不增加管理成本的基础上,取得了良好的管理效果。结论 FMEA可以评估医疗设备使用过程的失效,并能排序优先解决的问题,不增加管理成本就能预防问题的发生,是有效的过程管理工具。