从"病人选择医生"谈怎样做一个好医生

为了进一步体现医疗服务对病人自主性的尊重和病人对医生的信任,有利于医疗活动中调动患者的主动性和增强医生的责任感,提高医疗质量,减少医患之间的矛盾,建立和谐、密切合作的医患关系,许多医院推出了“病人选择医生”制度。这一医疗改革举措的实施,使病人有了自主权、主动权,医生成了被选者、被动者,也蕴育了竞争机制、激励机制和团队机制。它对医院提高医疗质量、改善服务态度有着积极的促进作用,深受广大患者的欢迎。然而仍然有不少慢性病患者反映,他们非常希望找到一位较固定的门诊医生为自己诊疗,因为他们经常往返于医院复诊,接触了许…     

浅论地区级医院病人选择医生的实施

1 研究背景意义为了贯彻落实国务院体改办等八部委《关于城镇医药卫生体制改革的指导意见》的精神。坚持以病人为中心,引入竞争机制,促进医疗机构内部运行机制改革。满足人民群众的医疗需求。为病人提供优质、高效、低耗的服务。卫生部、国家中医药管理局下达了《关于实行病人选择医生促进医疗机构内部改革的意见》。“让患者选择医生”的新型医疗服务模式,在全国一些大中型城市医院悄然兴起。病人选择     

强化医疗质量管理提升医院整体水平

医疗质量是医院生存和发展的根本，是医院建设的主题，关系到医院的生死存亡。随着我国医疗卫生事业的发展，特别是军队实施医疗保障制度改革以来，给医院带来了前所未有的机遇和挑战，也给广大医务人员提出了更高的要求，医院将面临着医疗服务质量和质量管理的严峻考验，能否以高质量的医疗水平赢得信誉，促进医院发展是医疗单位面临的一个重要问题，本文结合我院在强化医疗质量管理方面的工作体会谈几点看法。     

我院强化服务质量的几点做法

我院是由卫生队发展起来的医院 ,经过多年创业 ,使医院现拥有 14层医疗病房大楼 ,室内设施达北京市大医院一流水平。面对日益竞争的医疗市场 ,医院坚持“科技兴院 ,质量建院”的方针 ,强化优质服务 ,提高医疗质量建设。1　强化服务质量 ,坚持以病人为中心我院始终坚持以提高服务质量为核心 ,把全心全意为病人服务作为根本宗旨 ,教育全院人员牢固树立一切为临床 ,一切为病人的思想。制定了“强化服务质量 ,坚持以病人为中心 ,创一流服务实施方案”、“医院文明服务达标规则”、“医德医风建设规划和质量检测标准”等一系列优质服务措施 ,完善…     

浅谈护理工作如何适应新的医疗服务模式

面对日益激烈的医疗市场竞争及医疗体制的改革 ,出现新的医疗服务模式—“病人选医生”是形势所迫、时代所需 ,而新的医疗服务模式对医院的改革和提高医护质量都具有积极的促进作用 ,护理工作要适应新的医疗服务模式应必须有强烈的危机感、紧迫感 ,所以护理工作者只有转变观念 ,开拓创新 ,强化整体护理意识 ,用实际行动全方位提高护理人员的综合素质 ,才能主动适应新的医疗服务模式。1　进一步深化整体护理　　目前最新型的护理模式是整体护理。整体护理是以人为本 ,强调以病人为中心 ,以病人的利益和需求为中心 ,把病人看成是具有生理、心…     

看病还需多"问"病

通常情况下，大多数患在就医时，往往是医生问什么就答什么，很少有人主动向医生提问。在目前我国医疗体制尚不完善、医患关系还有待改进的情况下，患在看病时多“问”病、把有关问题问清楚就显得十分必要。同时看病多问病，也是保证寻医问药取得较好效果、减少医疗纠纷的有效途径。     

临床医生满意率调查与医疗质量改进

以改进临床医生医疗工作质量为目的,通过住院患者对医生满意度的调查,对医疗质量进行对比分析、适时讲评、意见反馈,有效地促进了对临床医生的质量管理。实施经常性的临床医生满意率调查,建立与之相配套的医疗质量改进制度,是行之有效的医疗质量管理方法。     

实行"院长助理值班制度"的几点体会

随着社会不断发展，医院的生存、发展必然会面对竞争，面临医疗市场的优胜劣汰。现代医学模式要求医院不仅仅局限于奉行“救死扶伤”的人道主义精神，应该在“以病人为中心”的指导方针上更加得以体现。2000年以来，我院实行院长助理值班制度，对完善医院管理，提高服务质量，密切医患关系     

851例门诊病人就诊情况调查分析

门诊是医院面向社会，直接为社会人群进行医疗和预防保健的场所。门诊工作的优劣，质量高低，直接地反映医院整体水平和综合能力，代表医院的形象。在医疗走人市场的今天，在社会普遍倡导“以病人为中心”的形势下，作为服务前沿的门诊，是吸引病人，创造收益的关键环节。笔者对某月到某医院就诊的门诊病人进行了抽样调查，分析病人就诊情况，从病人的角度来看医院工作的不足，以找出存在的问题，分析原因。为改革门诊工作提供依据。     

构筑先进医院文化打造核心竞争力

随着中国经济,社会的不断发展,随着中国加入WTO,国内医疗环境发生了巨大变化。医疗市场竞争已经同前几年单纯比拼硬件设备上升为比拼服务质量、医疗技术和就医环境;患者的要求提高了,医生的自我中心地位开始动摇,医院不得不对医务人员的服务意识、医院环境和高新技术的应用模式     

"Bubble-like" lung metastases in osteosarcoma patients

Purpose

Cavitation of pulmonary metastases have been reported by several authors either as a spontaneous phenomenon or as a consequence of chemotherapy. We present two cases, with this type of image in follow-up, and 20-45 months after the end of treatment. This was the first sign of pulmonary metastases.

Results

Two patients with osteogenic sarcoma developed radiological evidence of pulmonary “bubble-like” cavitation several years following completion of chemotherapy. In one patient the “bubble-like” cavitation transformed into a solid nodule. Both patients had surgical resections of all pulmonary lesions, and histology confirmed presence of viable osteosarcoma metastases.

Conclusion

The two cases suggest that onset of “bubble-like” cavitation in lung parenchyma of osteosarcoma patients may be the first sign of pulmonary metastases.     

Role of computed tomography in patients with "sciatica"

The computed tomography (CT) findings in 10 patients who presented with lumbosacral radicular symptoms are reported. The CT scans were performed after the more commonly used radiologic studies, including plain films and myelography, had failed to completely define the nature or extent of the underlying disease process. The final diagnoses were metastatic neoplasm to the spine and soft tissue in six cases, primary neoplasm of the sacrum or soft tissue in three cases, and tuberculous osteomyelitis and abscess in one case. The limitations and potential complications of the various radiologic examinations are discussed, and the potential value of CT in selected patients with lumbosacral neuropathy is presented.     

"Low-probability" ventilation-perfusion scintigrams: clinical outcomes in 99 patients

To evaluate the reliability of "low probability" ventilation-perfusion (V-P) scintigrams in excluding pulmonary embolism (PE), we reviewed the clinical records of 99 consecutive patients (74 in-patients and 25 outpatients) whose V-P studies had been interpreted as indicative of a low probability of PE. None of the 99 patients were referred for pulmonary angiography. Venography was performed in four patients and was positive in three. No patients were treated specifically for pulmonary embolism, but five received full treatment with anticoagulants for other reasons (three for venous thrombosis, one for a history of venous thrombosis, and one for a ventricular aneurysm). Seven of the hospitalized patients died during the index admission and seven additional hospitalized patients (including one treated with anticoagulants) died 1-5 months after discharge from the hospital. None were thought clinically to have died as a result of PE, and autopsy disclosed no PE in two. Follow-up information was obtained for 69 surviving patients (49 inpatients and 20 outpatients) not treated with anticoagulants. None of these patients were thought clinically to have had PE during follow-up of at least 2 weeks duration (greater than 2 months in 93% and greater than 6 months in 75%). Our results suggest that major short-term morbidity or death attributable to PE are quite infrequent in patients with low-probability V-P scintigrams.     

123I-MIBG myocardial scintigraphy in patients with "takotsubo" cardiomyopathy.

The clinical characteristics of reversible left ventricular dysfunction due to "takotsubo" cardiomyopathy have been described, but the origin of this condition remains unclear. This study investigated (123)I-metaiodobenzlguanidine ((123)I-MIBG) myocardial scintigraphy in patients with takotsubo cardiomyopathy. METHODS: Eight consecutive patients with takotsubo cardiomyopathy were studied. Left ventricular wall motion was monitored by echocardiography until wall motion normalized. (123)I-MIBG myocardial scintigrams were performed within 3 d of admission (0 mo) and after the improvement of left ventricular dysfunction (3 mo). Early images were obtained at 30 min after radioisotope injection and delayed images were obtained after 4 h. The heart-to-mediastinum ratio (H/M ratio) and the washout rate were calculated. RESULTS: The mean left ventricular ejection fraction improved significantly (from 42.8% +/- 8.7% to 66.5% +/- 7.9%; P < 0.0001) and normalized after 19.4 +/- 5.4 hospital days. The early H/M ratio was significantly higher than the late ratio at 0 mo (2.16 +/- 0.25 vs. 1.89 +/- 0.24, respectively; P < 0.05), but not at 3 mo. The washout rate was significantly greater at 0 mo than at 3 mo (39.1% +/- 10.2% vs. 25.4% +/- 6.3%, respectively; P < 0.05). CONCLUSION: In patients with takotsubo cardiomyopathy, initial (123)I-MIBG myocardial scintigraphy depicted a unique pattern of ventricular asynergy and indicated the existence of cardiac sympathetic hyperactivity, although coronary blood flow was maintained. These findings strongly suggest that takotsubo cardiomyopathy could be caused by neurogenic myocardial stunning.     

Chromosome changes in patients treated with "Myleran".

The aim of this study is the determination of chromosomal changes in patients suffering from chronic leucosis, after therapy with the cytostatic "Myleran", to find out whether this cytostatic causes them, because of clinical experience which indicates its value in the treatment of chronic myeloid leukemia. Patients were treated with therapeutic doses of 4 mg per os daily. Analysis with present methods in patients receiving relatively small total doses did not discover the other visible chromosomal aberrations in leucocytes in peripheral blood, except the usual aberrations caused by chronic leucosis.     

Management of patients with "ex vacuo" pneumothorax after thoracentesis

RATIONALE AND OBJECTIVES: To determine clinical outcome in patients who developed "ex vacuo" pneumothorax following thoracentesis and to assess the benefit of chest tube placement for this complication. MATERIALS AND METHODS: We retrospectively reviewed records of 282 patients who underwent 437 thoracenteses at a single institution during a 6-year period. We identified 34 patients (12.1%) who developed a pneumothorax following 39 thoracenteses (8.8%) and then identified a subset of patients with pneumothorax "ex vacuo" defined as a moderate to large hydropneumothorax or small pneumothorax persisting for more than 3 days. Patient charts were reviewed to document the treatment strategy employed and subsequent clinical outcome, which included length of hospital stay, resolution of pneumothorax, reaccumulation of pleural effusion, and overall survival. RESULTS: Ten patients developed "ex vacuo" pneumothroax following thoracentesis. None complained of significant worsening of symptoms following thoracentesis. Seven patients were treated by observation alone and 3 patients underwent tube thorocostomy. A decrease in size of the pneumothorax was observed in only 3 patients, none of whom had a chest tube placed. Effusion completely reaccumulated in 7 patients. All 10 patients died during the follow-up period; the mean survival was 157 days (range: 13-402 days). Survival among patients treated by observation was 191.4 days versus 71.7 days for patients receiving chest tubes. CONCLUSION: Life expectancy for most patients who develop "ex vacuo" pneumothorax following therapeutic thoracentesis is short (<6 months). Chest tube placement is not necessary in asymptomatic patients and is unlikely to provide clinical benefit.