医药费豁免是在医疗保障框架下对特定弱势群体的一种保护和托底机制.本文在总结医药费豁免的国际经验和中国实践的基础上,从逻辑起点、政策设计、推进路径、配套举措四个方面对完善我国医药费豁免制度进行思考,提出构建分层分类的医药费复合豁免机制及其可能路径,为我国深化医疗保障制度改革提供参考.

Deepening healthcare reform highlights the importance of medical services pricing adjustment, and the imperativeness to strengthen the informationized management of such pricing.With this concept in mind, the authors analyzed the problems and causes of the current management on medical service pricing informatization at public hospitals, and discussed the construction strategy of an intelligent error correction system in this regard. That is, to develop a technical process from the four aspects of software flow, interface flow, project rules, and reporting system. This system is designed with such functions as inpatient cost inquiry, inpatient information, price adjustment analysis, price feedback record statistics and inquiries over the hospitalization expense ceiling, as well as inpatient cost omission inquiry.This paper also discussed the construction of a platform to transform the knowledge of pricing policy into the knowledge base of medical service pricing, in order to improve the level of medical pricing management, promote the efficiency of hospital operation and management, and reduce the burden of patients.

目的 探讨小儿单孔腹腔镜疝囊高位结扎术手术护理体会.方法 对该院2017年1月—2018年11月119例5岁以下患儿使用改制双通道深静脉穿刺针在实施小儿单孔腹腔镜疝囊高位结扎手术,主要对术前护理、术中配合、小儿腔镜手术护理要点进行护理体会总结.结果 平均手术时长为(20.0±2.3)min,平均住院时间为(3±1)d.因术前禁食执行不严推迟手术6例,潜在感冒症状推迟手术3例,其余患儿均顺利实施手术.结论 小儿单孔腹腔镜疝囊高位结扎术具有损伤小、恢复快、住院时间短、费用低等优点,已经广泛在临床开展但规范精心的手术护理是体现该手术方式优点的有力保障.做好手术前的宣教是手术顺利进行的保障.

By analyzing the medical insurance policy, the medical insurance audit business and the intelligent monitoring requirements put forward by the medical reform, the intelligent examination and approval database was established, and the system process reengineering was carried out in conjunction with HIS, LIS and electronic medical record systems. The intelligent medical insurance audit information system was successfully developed and implemented, which realized automatic review of the medical qualifications of trauma patients, automatic audit of blood product items, automatic verification of high-cost fees, automatic review of repeated hospitalizations within 10 days, and automatic update of discharge diagnosis, as well as drug( diagnosis/treatment) project limits( excessive) early warning and other core business functions. The system meets the actual needs of the quality and efficiency of data management in medical insurance audit, providing basic platform and data support for standardizing doctors′diagnosis and treatment behavior and avoiding hospital risks.

Objectives: To investigate the clinical efficacy of psychological nursing for STD patients. Method: 126 STD patients selected in our hospital from March 2010 to March 2013 were randomly divided into the experimental group and the control group,63 cases in each group. Both groups received normal treatment,while the experimental group received extra psychological nursing. Results: The lengths of hospital stay in the experimental group were significantly fewer than that in the control group( P 0. 05). The clinical cure rate was 66. 67% in the control group,and 93. 65% in the experimental group. The difference was significant( P 0. 05). Conclusion: Psychological treatment can significantly improve the cure rate in the treatment of STD.

目的 通过对28例人工颈椎间盘置换术治疗颈椎病患者的精心护理,深入总结手术期间的护理要点和体会.方法 术前充分评估、测量和心理护理,术后严密观察病情变化和预防并发症.结果 28例人工颈椎间盘置换手术均顺利完成,患者术后均恢复良好,出院随访无术后并发症发生.结论 充分的术前准备,术后并发症的观察和护理是手术成功的关键,对促进患者康复有着重要的意义.

目的为了全面提高手术室护理质量,了解导致手术室护士产生心理压力的原因,采取针对性的预防措施。方法针对手术室护士心理压力的产生原因,采取针对性的预防措施,观察结果。结果手术室护士心理压力的产生原因以工作环境为主,其次为工作量大、工作时间长,医疗政策,护士的知识技能和社会地位低等。结论营造良好的工作环境,加强管理,提高护士的素质和社会地位是解决手术室护士心理压力的重要措施。

目的对40例颅内动脉瘤手术治疗的麻醉处理进行回顾性总结。方法全部患者行气管插管静吸复合全身麻醉。术中应用硝酸甘油复合艾司洛尔施行控制性降压;麻醉机施行控制呼吸。结果诱导后HR和MAP有显著性降低,但都在正常范围内。其他指标SpO2、PETCO2、CVP和ECG等均无大变化。全组无一例死亡。结论颅内动脉瘤手术治疗的麻醉诱导及维持要求平顺稳定,术中需施行控制性降压以避免脑动脉瘤破裂并减少出血。

目的观察神经阻滞器在闭孔神经阻滞麻醉下经尿道膀胱肿瘤电切(TURBt)术中使用的可行性和效果。方法在30例膀胱侧壁肿瘤行TURBt术前,使用神经刺激器定位行闭孔神经阻滞麻醉。结果 27例闭孔神经反射消失;3例仍有轻微的内收肌痉挛。TURBt术中无一例发生闭孔神经反射。结论利用神经刺激器辅助定位行闭孔神经阻滞,可以提高闭孔神经阻滞的成功率和质量,有效避免在TURBt术中因闭孔神经反射导致的膀胱穿孔和神经血管损伤。

<正>前列腺增生症是泌尿外科的常见疾病,随着医疗手段的提高,患者手术的成功率逐渐提升,同时也对护理质量提出了更高的要求。长期以来,护理工作都以常规护理操作为主,但健康教育在患者康复中的作用日益凸显,因此,加强对患者的健康教育尤为重要。本文基于对前列腺增生症患者所需健康教育内容进行的调查,明确了患者在住院期间最为关切的几个健康教育内容,对护理工作重点的明确有一定积极意义,现总结报道如下。

目的:探讨手术室整体护理在乳腺癌患者择期手术中的应用。方法:随机分为观察组42例和对照组39例,观察组采用系统化整体护理,对照组采用常规护理。结果:两组患者并发症发生率、术前5 m in和30 m in血压、心律、患者满意度比较差异均有统计学意义(P<0.05,P<0.01)。结论:系统化整体护理有效、可行,可减少并发症的发生,提高患者满意度。

目的提高医院医疗保险管理水平,保障参保者的切身利益。方法分析一所三级甲等医保定点医院的医疗保险管理难点,提出应对措施。结果通过转变观念、政策培训,加强与上级管理部门沟通等措施解决医院医疗保险管理工作中的难题。结论提高医疗保险保障水平和完善医疗保险制度是解决难点的关键。

Objective:To explore the methods of first aid and nursing care of the patients with severe thoraco-abdominal injuries. Methods:53 patients with severe thoraco-abdominal injuries were taken as study group and the other selected 36 patients with severe thoraco-abdominal injuries were taken as control group. The systematic and comprehensive first aid and nursing care were carried out in the study group and routine first aid and nursing care were applied in the control group. Results:In the study group,50 patients were cured,accounting for 94.34%; 2 patients died,accounting for 3.77%,one patient were discharged from hospital with his will,accounting for 1.89%; there was no death case and complication due to nursing care. In the control group,26 patients were cured,accounting for 72.22%,8 patients died,accounting for 22.22%,2 patients were discharged from hospital by their desire,accounting for 5.56%; severe complications occurred in 2 patients. The differences in the comparison between the two groups were statistically significant (P<0.05). Conclusion:The systematic and perfect first aid and nursing care can effectively improve the success rate of rescue and prevent the occurrence of complications.

将246例择期手术患者随机分为实验组140例和对照组106例,实验组在手术室全程护理中应用舒适护理的模式,对照组应用常规护理。结果实验组患者术前IIAMA分值显著低于对照组患者(P<0.01),配合治疗程度则明显优于对照组(P<0.01);生命体征变化比较,实验组患者在围手术期血压、心率、呼吸无明显变化(P>0.05),而对照组患者术中血压较术前升高、心率较术前增快、呼吸频率加速(P<0.01)。认为对手术室患者进行全程舒适护理模式,可减轻或解除患者对手术的焦虑,促进了患者对治疗的护理配合。

Objective To study the correlated of psychological defense mechanism,coping styles and mental health status in university students. Methods 751 students were tested by Symptom Checklist 90(SCL 90),Defense Style Questionnaire (DSQ) and Coping Style Questionnaire.Results Scores of SCL 90 in 183 students were higher than secondary severity degree,mainly manifested with interpersonal sensitivity,anxiety,hostility,obsession,depression,panic and paranoid ideation. Psychological defense mechanism and coping styles were affected their mental health status. It was negative correlation between mature psychological defense mechanism,positive coping styles and SCL 90 score,and positive correlation between middle mature psychological defense mechanism,non-mature psychological defense mechanism ,negative coping styles and SCL 90 score. Which manifested that mental defense mechanism with coping style and mental health existed intra relation. Conclusion Psychological defense mechanisms and coping style were correlated with mental health in university students; they should strengthen the training of psychological defense mechanisms and coping styles,and have effective psychological intervention,then to improve their mental health.

Objective To achieve win-win-win situation of patients,hospitals,health insurance by controlling health insurance costs.Methods The balanced scorecard was used as the management tools,to change the strategic goal of controlling medical insurance costs into measurable goals and methods from four dimensions of financial,patients,internal processes,learning and growth,and to achieve medical insurance cost-control.Results The cost-control appraisal indicator system of the medical insurance has been established based on balanced scorecard.The preliminary results showed that the number of discharge passengers,operating income increased significantly,the per capita number of hospitalization days,the per capita cost of hospitalization and the proportion of drug being significantly reduced.Conclusion Using the balanced scorecard as management tool can improve the overall efficiency of the hospital under ensuring the quality of medical care and controlling medical-insurance patients costs effectively.

我院自1996年开展健康教育以来,取得了卓越的成效,还获得了全国健康教育先进单位称号.我院开展的健康教育内容广泛,形式多样,单从形式上来讲,有一对一、一对多、多对多的形式,但采取多对一的形式还较少见.为了提高护理人员的健康教育能力,强化患者的健康教育效果,我院针对慢性病、多发病以及患者自身特点,采取护理人员与患者互动的方式开展多对一的健康教育,即健康教育护理查房,取得了较好的效果.现以高血压患者出院前健康教育的护理查房为例进行示范.

随着整体护理模式的普及与深化,我国医院的手术室普遍开展了术前访视.我院手术室于1997年开展整体护理,对手术患者实施术前访视,经过10 a的探索,三个阶段的发展,我院手术室的术前访视取得了较大成效,现报告如下.

Objective:To investigate the influence of the personality characteristics and psychological factor on attack of irritable bowel syndrome.Methods:99 patients from 2000 to 2006 in our hospital and normal group were tested by EPQ and SCL-90.Results:Compared with normal group,IBS group had significantly lower E factor score and higher N factor score of EPQ(P<0.01);Significant difference between IBS and normal group existed in the aspect of Somatization,depression,anxiety,Rivalry,dread,mental disease and positive item number.Conclusion:IBS exist in personality difference;abnormal psychological factor may influence the occurence of IBS.

手术室清点制度是手术室查对制度中的核心制度之一,是洗手护士和巡回护士共同在手术前及关胸腹前、后清点纱布、缝针、缝线、器械等是否相符,以免遗留体腔,防止差错事故的发生,保证手术患者安全一项重要制度.洗手护士和巡回护士对于清点工作极为重视,极其认真负责,但是,在清点工作中,仍存在一些安全隐患,需加强防范,以确保手术安全顺利完成.探讨如下.