U. S. Academic Medical Centers Under the Managed Health Care Environment

This research investigates the impact of managed health care on academic medical centers in the United States. Academic medical centers hold a unique position in the U. S. health care system through their missions of conducting cutting-edge biomedical researeh, pursuing clinical and technological innovations, Providing state-of-the-art medical care and producing highly qUalified health professionals. However, policies to control costs through the use of managed care and limiting resources are detrimental to academic medical centers and impede the advancement of medical sciTo survive the threats of managed care in the health care environment, acadendc medical centers must rely on their upper level managers to derive successful strategies. The methods used in this study include qualitative approaches in the form of key informants and case studies. In addition, a survey questionnaire was sent to 1h8 CEOs in all the academic medical centers in the U. S. The findings revealed that managers who perform the liaison, monitor, entrepreneur and resource allocator roles are crucial to ensure the survival of academic medical centers, so that academic medical centers can continue their missions to serve the general public and promote their well-being.

Research of the Exploitation of Human Resources in Blind Prevention and Primary Eye Care

Purpose:This research studied how to establish a relatively advanced blindness prevention and eye care cause in economically underdeveloped countryside.Methods:Ophthalmic vocational schools and professional lectures were held to train“practical type”primary eye care workers for the coumtryside.Further study in high-level(above provincial)hospitals was taken to train blindness preention &eye care backbones and leaders.Results:In 1986,the ratio of the number of the eye care workers of all levels to the number of the whole population in the prefecture was1:26000.In1992,it roseto1:17000.Aneye care network of 222stations had been established in tb countryside.Ten in the 13county hospitals had a seperated ophthalmology ed- partment,in which 3were awarded“National advanced blindness prevention County”.Twenty one hospitals were appointed as the Unit of Surgical Vision-Rehabilitation of Cataract.Blindness prevention and eye care convered1000000population(eye care avaliable within 5kilometers),23.5%of the whol popula-tion.Conclusions:In a demographically large but economically underdexeloped country-side area,the key to wide-range blindness prevention and eye oare is to exploti human resources effectively.We should train“Practical type”primary eye care workers,and have a number of edpartment leaders who are authoritive,influential in this field and ready to sacrifice to this cause.

缓和医疗之理解与责任

缓和医疗的发展方兴未艾,但临床对其认识仍然浅显,且可能存在较大偏颇。本文从缓和医疗的本源出发,阐释缓和医疗的内涵以及重要性,以期加深医务工作者对缓和医疗的理解,从而推动缓和医疗理念在临床的贯彻实施。

缓和医疗存在的争议

关于缓和医疗,一直以来主要存在两方面争议:一是缓和医疗照护对象范围是否应扩大,二是缓和医疗的介入时机是否应提前。目前对于上述争议已达成的基本共识包括:缓和医疗照护对象应扩大至身患严重疾病、遭受重大痛苦的所有年龄段患者;缓和医疗应早期整合至严重疾病的治疗全过程。然而,缓和医疗照护对象范围的扩大及介入时机的提前同时带来了新的挑战,亟待制定新的战略计划并加以实施,以加快探索适合我国国情的缓和医疗发展之路。重新认识缓和医疗照护对象及介入时机,有助于加快我国缓和医疗的发展。本文从缓和医疗发展史、定义更新、现有证据及研究进展三方面,结合临床实际需求,针对该两大焦点问题展开论述,以期为我国缓和医疗实践提供参考。

医学教育中人文关怀精神培育面临的问题及分析

医学科学精神和人文关怀精神是培养医学人才的“双引擎”,而人文关怀精神的塑造与医学生的价值取向、价值目标正确与否密切相关。人文关怀精神的培育目前已经成为高等医学院校大学生素质教育工作中的一项重点内容。总体来说,医学人文关怀精神培育还存在弱化的现象,难以满足现代医学生培养的需要。健康中国战略也需要医学人文关怀精神。医学院校应该在加强和改进高校思想政治工作的利好局面下,转变教育观念,加强医学人文关怀教育,从人文关怀教育培养目标、课程设置、教学计划、教学内容、教学方法与手段等方面开展医学人文教育教学改革,构建医文相通的教师队伍,开展高质量的校园文化活动,营造医学人文氛围,从而为“健康中国”输送“医术高超、情操高尚”的医学人才。

医学照护能力:内涵、结构及其培育方式

医学实践不仅要求医护人员运用技术手段去除患者的身体痛苦,同时还要给予患者心理、社会和精神层面的全方位照护,因此需要医护人员具备医学照护能力。医学照护能力是医护人员开展照护活动所需的心理倾向和行为特征的总和,是实现医学目的的重要手段,包含动机、知识和行动方式三要素。作为一种具有利他主义特征的行为能力,合理的动机是实施医学照护的前提,同时还需要医学人文与技术知识的支持。行动方式是医学照护能力的最终表现,包括技术操作、有效沟通和建构社会支持系统等多个方面。中国的医学教育长期忽视对于这一职业能力的培养,为此需要做出系统性的变革,包括在教育理念方面注重医学职业美德的可实践性,以提升照护能力为目标改革教学内容,同时还要丰富教学方法和评价方法等,从而有效促进医学生医学照护能力的形成与提高。

医学人文融入医疗服务实践的理论探究

如何在医疗服务中践行医学人文,是医学人文学科的根本问题和最终价值所在,也是优质医疗服务发展的迫切需求。梳理医学人文实践措施是医学人文的理论向度和实践向度相结合,以及医学人文理论融入、引领医疗服务实践的必要准备。当下我国医学人文实践的主要矛盾是人民日益增长的“有温度的医学”需要和医学人文服务供给内容和供给水平不足之间的矛盾,而在这一主要矛盾中,供给侧是矛盾的主要方面。因此,医学人文实践的理论起始点为供给理论,与协同理论、渐进理论以及客户关系管理理论共同构成医学人文实践的整体理论框架。供给理论明确了供给侧是医学人文实践的主要方面,指明了焦点为供给侧。协同理论解决的就是供给方的范围和组织原则,而渐进理论解决的是供给方决策尺度的指导原则。客户关系管理理论适用于医方和患方之间的关系,诠释了供给方和需求方的关系,把供给和需求链接起来。对医学人文实践措施的分析应该从以下10个维度展开:类型、特点、应用场景、环节、成本、操作的难易程度、考核的难易程度、可复制性、与医学人文结合的深度以及实施周期。

叙事医学与临床心灵关怀的融合与探索:心灵叙事

探讨了叙事医学与临床心灵关怀的交汇融合,特别是心灵叙事在医疗服务中的重要性和价值。心灵叙事基于叙事医学的三要素,结合临床心灵关怀的专业素养,实现对患者生理、心理、社会、心灵等多角度的关注,疾病故事中个体之间的联系与情境在心灵叙事中再现,使得叙事者以更多元的视角去深入理解自我、他人与自然事件之间的关系,从而提高医者的角色认同感和职业幸福感,最终促成叙事者对自我内在的探索,对生命哲理的领悟。将叙事医学融入湖南省肿瘤医院临床心灵关怀项目的本科教学、研究与临床实践,开展心灵叙事,对提高医学生和临床医务人员的同理心、沟通力,促使其思考和理解生命的意义,增强其以人为中心的临床思辨能力具有重要意义。

一起动物诊疗机构将人用药品用于动物案的评析

2024年3月,A市农业行政执法机构在执法检查中发现,B动物诊疗机构涉嫌将人用药品用于动物。经立案调查,认定该违法事实存在,根据《兽药管理条例》依法进行了处理。本文对该起动物诊疗机构使用人用药品的违法案件进行剖析,重点围绕“单位”与“个人”的区别以及“无害化处理”“一事不再罚”“没收违法所得”等问题展开探讨,并结合问题提出了建立人用药品兽用清单制度,探索宠物诊疗领域首违不罚制度,明确动物诊疗活动中的主体责任,强化动物诊疗联合执法机制等思考建议,以期为农业行政执法人员查处同类案件提供参考。

基于成本效益对比分析病案无纸化

病历管理是医院提供医疗服务的重要基础工作之一。近年来,随着国内外医疗服务需求的快速增长,各级医院产生了大量的病历,迫切需要更先进的管理解决方案来有效整合病历。在这种背景下,无纸化记录可以成为医院促进医疗数据使用和提高医疗服务水平的重要工具。本文通过深入研究和分析,发现电子病历解决方案建设成本高,长期运营成本低,更符合无纸化病历发展方向,呈现出区域化、标准化、智能化的特点。

医学人类学视角下侗族村落多元化医疗模式研究

侗族村寨中多元医疗模式的形成与共存是医学人类学研究内容之一。侗族村寨多元化医疗体系包括传统医学、宗教巫术和现代医学在侗族文化中的交融与互补。在文化“主位”“客位”分析下,阐释了多元医疗模式的文化合理性,展示了文化内部的自给自足和对外部知识的开放接纳。从文化功能、文化自资的角度审视,发现多元医疗模式不仅提供全面的健康保障,而且强化社会凝聚、文化传承和身份认同。研究揭示了侗族村寨多元医疗模式的必然性,体现了社区对自身文化、自然环境和现代社会的深刻理解,为跨文化医学的理论与实践提供了丰富的经验范本。

Humanistic caring:the core of nursing

The voice of calling for humanistic concern is always from uncountable doctor-patient conflicts, from which we often hear a doctor is killed or injured for disputes. Prejudice has been rooted in mind that all doctors and nurses are interest-centered and cold-blooded. To some extent, it's true that patterned questions with a poker face are always more than gentle words with warm smile. Nurses are the ones who keep patients company for the longest time. Therefore, caring matters more for them. The explicit concept of "caring" will be introduced and we will attach great importance to how nurses can achieve caring. From the following aspects:the practices of loving kindness, the instillation of faith and hope, sensitivity to indicators of disease, improvem ent of healing environment, communication arts etc, you will understand why nurse is the symbol of angel. We can begin with caring about people around us. Our duty is not only to deal the ill but to warm the chill.

Promoting Clinician Well-Being and Patient Safety Using Human Factors Science: Reducing Unnecessary Occupational Stress

Our healthcare delivery system has accumulated complexity of payment, regulation systems, expectations and requirements. Often these are not designed to align with clinical thinking process flow of patient care. As a result, clinicians are utilizing enormous mental (cognitive) resource to comply with these complexities, over and above the baseline mental effort required to give good care to the patient. Recent studies suggest a significant number of physicians, advanced practice providers and nurses no longer want to stay in healthcare due to difficult work expectations and conditions that have become unreasonable. Technology has benefitted healthcare delivery, but also is a conduit of many expectations that have been grafted upon clinician workloads, exceeding the resources provided to accomplish them. Cognitive load is a measure of mental effort and is divided into Intrinsic, Germane and Extraneous Cognitive Load. Extraneous Cognitive Load (ECL) is what is not necessary and can be removed by better design. High cognitive load is associated with increased risk of both medical error and clinician burnout. Chronic high level occupational stress occurs from dealing with this job/resource imbalance and is showing serious personal health impact upon clinicians and the quality of the work they can provide for patients. Since organizational systems have become more complex, leadership methods, clinician wellbeing and patient safety efforts need to adjust to adapt and succeed. Safety efforts have tended to predominantly follow methods of a few decades ago with predominant focus upon how things go wrong (Safety I) but are now being encouraged to include more of the study of how things go right (Safety II). Human Factors/Ergonomics (HFE) science has been used in many industries to preserve worker wellbeing and improve system performance. Patient safety is a product of good system performance. HFE science helps inform mechanisms behind Safety I and II approach. HFE concepts augment existing burnout and safety interventions by providing a conceptual roadmap to follow that can inform how to improve the multiple human/technology, human/system, and human/work environment interfaces that comprise healthcare delivery. Healthcare leaders, by their influence over culture, resource allocation, and implementation of requirements and workflows are uniquely poised to be effective mitigators of the conditions leading to clinician burnout and latent medical error. Basic knowledge of HFE science is a strategic advantage to leaders and individuals tasked with achieving quality of care, controlling costs, and improving the experiences of receiving and providing care.

Challenges of the dialog between humanization of health and medicine for the assistance to woman health in the Brazilian scenario

The present article aims to present, by a bibliographic review, the current challenges of the dialog among fundamental issues referring to humanization as for current public policy in Brazilian scenario. The first one concerns with national health humanization policies and ultimately the humanization of the assistance to the woman’s health, especially at delivery and child birth. Using the hermeneutic dialectic as methodology, it’s understood that having these three facets, dialog consists not only of a great challenge but also of a condition on being put into practice, and expected issues become an effective reality.

C-反应蛋白诊断不同类型儿童流感病毒感染的价值研究

目的探讨C-反应蛋白(CRP)是否与甲型流感或乙型流感病情相关,并评价CRP检测诊断ILI的价值。方法选择2020年11月至2021年1月季节性流感流行期间医院收治的ILI患儿进行分析,统计患者一般资料,分析CRP水平与症状的关联,探讨甲型或乙型流感与CRP水平的相关性。结果277例诊断流感样疾病患者中甲型流感121例(121/277,44%),乙型流感58例(58/277,21%)。根据CRP浓度无法确诊甲型流感患者,而CRP每增加10 mg/L则相应乙型流感显著降低,优势比为0.42(0.25~0.70,P<0.01)。临床症状上中重度症状呼吸急促、出汗、头晕等与CRP水平较高有关。结论CRP与甲型流感无关联关系,而CRP浓度增高与乙型流感风险降低有关。除非怀疑细菌感染时候,一般情况下不考虑利用CRP诊断ILI。

糖尿病护理中人性化护理的应用效果分析

探究糖尿病护理中人性化护理的应用效果。选取泰安市中医二院2021年12月—2023年7月收治的60例糖尿病患者为研究对象,将患者随机分为两组,分别为对照组和观察组,每组各30例。对照组实施常规药物护理,观察组实施人性化护理。对比两组患者护理效果。结果显示,观察组患者血糖指标、遵医行为、实验室指标、心理状态评分、并发症发生情况优于对照组(P<0.05),护理满意度、护理质量评分、生活质量评分、希望水平评分高于对照组(P<0.05)。研究发现,糖尿病护理中人性化护理的应用效果显著优于常规药物护理,因此人性化护理更具推广价值。

政策工具视角下医养结合机构医生相关政策分析

目的:对医养结合机构医生相关政策进行本文分析,为后续政策的制定与完善提供参考。方法:基于政策工具和人力资源管理功能维度建立二维分析框架,对医养结合试点城市出台的304份政策文件进行量化研究。结果:在政策工具维度的1772项编码条目中,需求型、供给型、环境型政策工具分别占7.22%、58.35%、34.42%;人力资源管理功能维度的1110项编码条目中,选拔、培育、使用、保留人员环节的政策分别占11.89%、40.63%、33.42%、14.05%。结论:优化供给型政策工具的子类政策分布,增加需求型政策工具的使用,细化环境型政策工具任务举措,填补政策工具的人力资源管理功能弱项。

贵州省公立医院口腔医护人力资源及卫生服务现状调查

目的 了解贵州省公立医院口腔医护人力资源及卫生服务现状并分析现存的问题。方法 于2021年12月-2022年3月通过问卷形式对贵州省61所公立医院口腔科的口腔医护人力资源情况、口腔护士职责范围及口腔医疗卫生服务现状进行调查,并对数据进行分析。结果 本研究调查的61所公立医院中包括986名医生和694名护士,医护人数比为1.42∶1,其中医生高级职称占比为21.71%,护士高级职称仅占3.45%;口腔医生和护士学历以本科为主,口腔护士暂无博士研究生学历;护士主要集中在口腔门诊工作,四手操作开展情况较差,全省未开展口腔专科护士培训,未开展互联网+口腔护理服务。结论 贵州省公立医院口腔医护比、职称及学历层次不合理,且口腔护士卫生服务能力较弱。

Lidar-Based Action-Recognition Algorithm for Medical Quality Control

Medical-action recognition is crucial for ensuring the quality of medical services.With advancements in deep learning,RGB camera-based human-action recognition made huge advancements.However,RGB cameras encounter issues,such as depth ambiguity and privacy violation.In this paper,we propose a novel lidar-based action-recognition algorithm for medical quality control.Further,point-cloud data were used for recognizing hand-washing actions of doctors and recording the action’s duration.An improved anchor-to-joint(A2J)network,with pyramid vision transformer and feature pyramid network modules,was developed for estimating the human poses.In addition,we designed a graph convolution network for action classification based on the skeleton data.Then,we evaluated the performance of the improved A2J network on the open-source ITOP and our medical pose estimation datasets.Further,we tested our medical action-recognition method in actual wards to demonstrate its effectiveness and running efficiency.The results show that the proposed algorithm can effectively recognize the actions of medical staff,providing satisfactory real-time performance and 96.3% action-classification accuracy.

基层医疗卫生机构人力资源管理中激励策略的应用分析

当前,许多基层医疗机构的人力资源管理水平跟不上医疗卫生事业发展的步伐,基层医疗机构的人力资源管理存在许多问题,比如基础医疗机构没有健全的人力资源竞争体系、没有对人力资源管理进行科学规划和合理供给预测、高层次的专业人才大量流失、没有专业的人才管理理念与人才激励机制,这给人力资源管理工作带来了很大的压力。基层医疗机构要提高医疗服务质量,尽快进行资源管理,通过应用激励策略,探讨人力资源激励策略实施的优势。在此基础上,本文提出了加强基层医疗工作人员福利保障、全面支持基础医疗设施建设、关注工作人员的物质奖励和精神激励等措施,旨在为相关人员提供参考,以增强基层医疗队伍的人才凝聚力,迎接新的挑战。