三种内固定方法治疗股骨远端骨折分析

目的比较髁钢板(95°)、动力髁部螺钉(DCS)、逆行交锁髓内钉治疗股骨远端骨折的临床疗效。方法对采用以上三种内固定治疗股骨远端骨折共计66例功能优良率、手术并发症进行分析。结果逆行交锁髓内钉组疗效最好、功能优良率高、并发症少。结论逆行交锁髓内钉内固定法治疗股骨远端骨折疗效确切,与其它两种方法相比,此内固定物更符合人体生物力学原理,术后不需外固定,功能恢复快、并发症少,是目前治疗股骨远端骨折较好的内固定材料。     

顺行交锁髓内钉在肱骨干复杂型骨折治疗中的应用

目的探讨顺行交锁髓内钉治疗肱骨骨干复杂型骨折的临床效果。方法选取2010年到2012年我院收治的肱骨干复杂型骨折患者64例作为此次研究对象并随机分为实验组和对照组各32例。实验组患者采用顺行交锁髓内钉进行治疗,而对照组患者则使用钢板内固定的方法治疗。比较实验组和对照组患者的各项临床指标以及并发症发生情况。结果两组患者经过不同的手术治疗后,实验组骨性愈合时间和对照组比较差异无统计学意义(P>0.05),两组均有2例发生骨折延迟愈合。术后两组患者均出现了并发症,但实验组的并发症总人数与对照组比较差异有统计学意义(P<0.05)。对实验组和对照组患者进行NEER评定后,两组的优良率差异无统计学意义(P>0.05)。结论顺行交锁髓内钉与钢板内固定治疗肱骨骨干复杂型骨折均有一定的临床疗效,但两者相比较,顺行交锁髓内钉术后并发症发生情况更少,更值得临床推广。     

Management techniques at primary care health centers: the impact of management innovation

Long-term financial viability was a goal of The Program to Strengthen Primary Care Health Centers. To accomplish this, it was expected that participant centers would increase their management capabilities. We evaluated 32 management techniques in five principal areas: budgeting, strategic planning, general financial management, collections, and general health services management. Eight of the techniques showed change over the course of the demonstration (six increases and two decreases). It appears that there was somewhat more improvement among study centers than in a comparison group. Management sophistication has been expanding among health centers in general; Program participation appears to have accelerated this growth.     

Straight talk: new approaches in healthcare. Working toward true excellence: employers press for change

Although the concept for centers of excellence has been around since the 1980s, few centers are more substantive than a sign on the door. But the marketing-only approach to centers of excellence won't work much longer. That's because employers now are taking a more active role in defining and monitoring the quality and cost of healthcare services. This new breed of proactive employer uses outcomes and other quantitative information to determine which centers truly are places of excellent care at reasonable cost. The Washington-based Leapfrog Group is the most visible example of employer activism in healthcare. Founded in 1999 as a coalition of Fortune 500 companies and purchasing groups, Leapfrog has developed standards to evaluate patient safety at hospitals. It plans to publish on its website consumer-friendly information about how well hospitals meet those standards. In the sixth installment of Straight Talk, we examine the critical elements of a true center of excellence--from both the provider's and employer's points of view. We also talk about the impact Leapfrog might have on the direction these centers take in the future. Modern Healthcare and PricewaterhouseCoopers present Straight Talk. The session on centers of excellence was held on September 10, 2002 at Modern Healthcare'sChicago headquarters. Charles S. Lauer, publisher of Modern Healthcare, was the moderator.     

Clinical Quality Performance in U.S. Health Centers

Objective

To describe current clinical quality among the nation''s community health centers and to examine health center characteristics associated with performance excellence.

Data Sources

National data from the 2009 Uniform Data System.

Data Collection/Extraction Methods

Health centers reviewed patient records and reported aggregate data to the Uniform Data System.

Study Design

Six measures were examined: first-trimester prenatal care, childhood immunization completion, Pap tests, low birth weight, controlled hypertension, and controlled diabetes. The top 25 percent performing centers were compared with lower performing (bottom 75 percent) centers on these measures. Logistic regressions were utilized to assess the impact of patient, provider, and institutional characteristics on health center performance.

Principal Findings

Clinical care and outcomes among health centers were generally comparable to national averages. For instance, 67 percent of pregnant patients received timely prenatal care (national = 68 percent), 69 percent of children achieved immunization completion (national = 67 percent), and 63 percent of hypertensive patients had blood pressure under control (national = 48 percent). Depending on the measure, centers with more uninsured patients were less likely to do well, while centers with more physicians and enabling service providers were more likely to do well.

Conclusions

Health centers provide quality care at rates comparable to national averages. Performance may be improved by increasing insurance coverage among patients and increasing the ratios of physicians and enabling service providers to patients.     

Facilitating the development of moral insight in practice: teaching ethics and teaching virtue

Abstract The teaching of ethics is discussed within the context of insights gleaned from ancient Greek ethics, particularly Aristotle and Plato and their conceptions of virtue (arete, meaning excellence). The virtues of excellence of character (moral virtue) and excellence of intelligence (intellectual virtue), particularly practical wisdom and theoretical wisdom, are considered. In Aristotelian ethics, a distinction is drawn between these intellectual virtues: experience and maturity is needed for practical wisdom, but not for theoretical wisdom. In addition to this, excellence of character is acquired through habitual practice, not instruction. This suggests that there is a need to teach more than theoretical ethics and that the ethics teacher must also facilitate the acquisition of practical wisdom and excellence of character. This distinction highlights a need for various educational approaches in cultivating these excellences which are required for a moral life. It also raises the question: is it possible to teach practical wisdom and excellence of character? It is suggested that virtue, conceived of as a type of knowledge, or skill, can be taught, and people can, with appropriate experience, habitual practice, and good role models, develop excellence of character and become moral experts. These students are the next generation of exemplars and they will educate others by example and sustain the practice of nursing. They need an education which includes theoretical ethics and the nurturing of practical wisdom and excellence of character. For this purpose, a humanities approach is suggested.     

2008年全国妇幼保健机构职能履行现状分析

目的:通过对2008年全国2 767所妇幼保健机构的群体保健工作以及医疗保健技术服务的调查,掌握全国妇幼保健机构职能履行情况。方法:基于现代化的网络传输系统开发《全国妇幼卫生机构管理信息网络报告系统》,实现信息网络实时直报。结果:大部分妇幼保健机构开展了多项群体保健服务管理工作,医疗保健技术服务工作开展较顺利;辖区群体保健服务有待提高。结论:政府应加大对妇幼保健机构人力、物力、财力的投入,重视妇幼保健人才队伍的培养,完善妇幼卫生管理机制,促进妇幼保健机构规范化建设。     

The EFQM excellence model is useful for primary health care teams

BACKGROUND: Primary care teams are facing an increased need to develop quality programmes at local level. GPs must lead this process and promote a positive organizational culture if they want to achieve and maintain a continuous improvement of the service. OBJECTIVE: The aim of the present study was to test the applicability and reliability of the European Foundation for Quality Management (EFQM) excellence model self-assessment questionnaire in a primary health care organization. METHOD: A cross-sectional study was carried out of the EFQM questionnaire to compare the scores achieved by a primary health care team in Spain caring for 42 000 inhabitants using internal self-assessment with the scores achieved by professional management auditors through an external audit. RESULTS: The scores of each criterion achieved by self-evaluation are similar to or lower than those assessed by the external evaluation. There is agreement in the areas suitable for improvement. CONCLUSIONS: The experience proves the applicability of the EFQM excellence model for primary health care teams and its reliability, at least when the team undergoing self-assessment know they are going to be re-evaluated. There is high concordance in the identification of areas for improvement.     

广东省疾病预防控制机构信息系统建设与应用

目的 了解广东省市、县级疾病预防控制中心信息系统建设现状,提出发展对策.方法 对广东省115个市、县级疾病预防控制中心进行问卷调查,采用SPSS 10.1软件进行统计分析.结果 实际调查110个市县级疾病预防控制中心.个人计算机配置率为45.2%;分别有50.5%,27.1%和11.5%的单位建立了局域网、网站和办公自动化系统;99.1%接入了互联网,76.9%安装了专业防病毒软件;100%应用了中国疾病预防控制信息系统;分别有18.0%,19.0%和19.8%的单位自主建立了疾病监测信息系统、卫生学监测信息系统和实验室管理信息系统;分别有44.1%,37.9%和33.7%的单位使用了从业人员健康体检信息系统、财务管理系统和继续教育管理系统.所建立的信息系统中,52.8%为购买商品化软件,39.1%为委托公司开发.其中,65.7%业务类软件由委托公司开发,78.1%管理类软件为购买商品化软件.结论 广东省疾病预防控制系统信息化建设尚处在初级阶段.在未来几年里必须加快建设,以实现国家提出的2010年达到中等发达国家水平的卫生信息化发展目标.     

Forecasting menu-item demand in foodservice operations

The state of the practice in forecasting menu-item demand in foodservice operations was determined. A survey to assess the forecasting techniques utilized by foodservice directors was administered to a random sample of 834 American Dietetic Association Members with Management Responsibilities in Health Care Delivery System. Statistical analysis of the 392 responses revealed that less than 25% of the practitioners were using mathematical models in forecasting menu-item demand. Naive models were utilized by the majority of the respondents. The moving average technique was the most frequently used (14.8%) mathematical model. Approximately 75% of the practitioners indicated that continuing education is needed relative to the forecasting techniques that may be employed in foodservice management.     

An expanded model of faculty vitality in academic medicine

Many faculty in today’s academic medical centers face high levels of stress and low career satisfaction. Understanding faculty vitality is critically important for the health of our academic medical centers, yet the concept is ill-defined and lacking a comprehensive model. Expanding on previous research that examines vital faculty in higher education broadly and in academic medical centers specifically, this study proposes an expanded model of the unique factors that contribute to faculty vitality in academic medicine. We developed an online survey on the basis of a conceptual model (N?=?564) and used linear regression to investigate the fit of the model. We examined the relationships of two predictor variables measuring Primary Unit Climate and Leadership and Career and Life Management with an overall Faculty Vitality index comprised of three measures: Professional Engagement, Career Satisfaction, and Productivity. The findings revealed significant predictive relationships between Primary Unit Climate and Leadership, Career and Life Management, and Faculty Vitality. The overall model accounted for 59% of the variance in the overall Faculty Vitality Index. The results provide new insights into the developing model of faculty vitality and inform initiatives to support faculty in academic medical centers. Given the immense challenges faced by faculty, now more than ever do we need reliable evidence regarding what sustains faculty vitality.     

Quality in early education and care: What do we mean?

"Quality early childhood education and care” has become a slogan. In New Zealand we do not seem to have a clear understanding of what quality in early education and care is even though it is our mission to secure and enhance it. Considerable overseas research on the characteristics of quality in early childhood centres has been carried out, yet there is no simple answer to the question of what quality is. Quality may be taken to mean either the character of a centre or its excellence; Quality may be viewed at either the programme level or the service level. No single measure is possible because various approaches to defining and assessing quality may be used. In this paper it is suggested that we need to know what is important from the perspectives of staff, parents, different cultural groups, and child development research findings if we are to promote the quality of early education and care in New Zealand.     

Assessment of and intervention for the misuse of aldehyde disinfectants in Japan.

A survey of 145 Japanese hospitals revealed the use of 4 inappropriate aldehyde disinfection methods in 5.5% to 16.8%. Following education, there was discontinuation of 3 of these practices in 26 of 28 affected centers, but only 4 of 18 affected centers stopped the use of formaldehyde vapor cabinets. There is a need to inform hospitals about inappropriate disinfection methods that pose chemical risks to patients and staff.     

实验室信息管理系统的开发与应用探讨

实验室信息管理系统（LIMS）是一个用于检测实验室管理的软件系统。文章简要介绍了实验室信息管理系统（LIMS）的基本原理及发展情况，重点提出了检测实验室LIMS系统所具备的系统结构及相关功能，并讨论了现有检测实验室LIMS系统所要重点解决的问题，从而为LIMS系统在检测实验室的改进、提高、应用奠定基础。     

Craniofacial anomalies: description and evaluation of treatment under the Brazilian Unified Health System

The first initiative for treating craniofacial anomalies under the Brazilian Unified Health System was in 1993. An important step was the creation of the Reference Network for Craniofacial Treatment. There are now 29 services listed in this Network. The current study aimed to describe and assess the general characteristics of healthcare in this Network. Data were collected by a questionnaire, sent to the centers. Response rate was 86.2%. The results showed an increase in services in Southeast Brazil, in universities, and in relation to cleft lip and palate; public financing was prevalent; team composition was largely in accordance with North American standards; routine care occurred in 90%; and 70% used clinical protocols. The Network's name does not appear to entirely reflect its scope. The results show the need to review the Network's definition, aims, and achievements and the standards for inclusion of craniofacial centers.     

Product-line administration in hospitals

While a great deal of discussion has centered on product-line planning and management, product-line marketing may be even more important. Defining its market increases the hospital's ability to achieve its mission, improve its vitality, and attract medical staff. By focusing on specific programs or products, the hospital may be able to develop "centers of excellence" that attract patients and referrals from a wide area.     

Contribution of regional networks to the nutrition education of physicians.

To describe the activities of existing nutrition education consortia and their efforts to support nutrition education in medical schools and residency programs.

In an effort to improve nutrition education at member schools, regional consortia have: organized conferences and courses for faculty, fellows, residents, and students, developed curricula, fostered networking among faculty with shared interests, provided awards for excellence in teaching and research to faculty and students, collaborated with dieticians and non-physician faculty, prepared protocols for evaluation including formal tests, feedback techniques and preparation of Observed Structured Clinical Evaluation (OSCE). The structure and activities of two existing regional centers are described.

Goals and objectives for nutrition education have been established, but there remains a significant need for improvements in outcome measures.

Regional networks have been active in supporting nutrition education in those medical schools which have participated, and they have made contributions to the literature on nutrition education for medical students. A specific advantage of the regional center concept is the ability to pool the resources of many schools, each with a limited number of faculty interested and knowledgeable in nutrition.

The activities of the two Regional Centers suggest that medical school nutrition education programs can gather strength beyond that available at any single institution by forming a regional network. Collaboration of regional networks might offer a means to significantly improve medical student nutrition education. Future efforts, however, require closer attention to the need for evaluation of effectiveness.     

Intuition and the nurse manager

In spite of the present move in health care into the computer age, there is increasing awareness that intuition is an important nursing management technique and that it is linked to success as a manager. Intuition is most effectively implemented by the self-confident manager with experience and expertise as a manager. Nevertheless, a novice manager who values and seeks intuition will find it a technique that will assist in the development of excellence as a manager. Managers who perceive themselves as having limited skills in intuition and yet are sensitive to the need for intuition can compensate for this deficiency by close association with a coworker who can provide intuitive perceptions and evaluations. For example, a head nurse who is primarily analytical may discuss assignment of nurses with an assistant who is highly intuitive. Managers who are able to compensate for intuitive deficiencies by surrounding themselves with competent and trusted subordinates who have intuitive qualities may be able to effectively use both analytic and nonanalytic managerial techniques.     

《军队干部体检信息管理系统》开发与应用

《军队干部体检信息管理系统》是针对军队干部体检要求编制的一套管理软件，规范了军队体检工作流程，实现了体检全过程的信息化管理。介绍了软件编写指导思想及采用的关键技术，分析了在全军推广使用后产生的效益，并提出了改进方向。     

医院信息系统与医疗保险信息系统接口的设计与实现

近年来余杭区第二人民医院十分重视信息管理系统的建设,在医保信息系统建立的2年前医院信息管理系统(HIS)软件就已正常运行.如何将医院信息系统和医保信息系统有机地结合在一起,使之既符合医保的需求,又适合医院的实际,便成为一个突出问题.文章主要探讨余杭区第二人民医院信息管理系统与余杭区医保中心的信息系统软件接口的设计及硬件实现过程.