目的 探究影响江苏省某三甲医院患者安全文化认知的因素,并对其展开分析及提升策略研究,为医院进一步提升患者安全、提高医疗安全质量提供方法和对策.方法 采用问卷调查法、简单随机抽样法,以医院患者安全文化问卷为调查工具,共收回有效问卷779份,对基本情况采用描述性统计,对不同特征研究对象的认知现状进行方差分析,对患者安全文化的影响因素运用多重线性回归分析,以P＜0.05表示差异有统计学意义.结果 该院职工患者安全文化的总体平均得分为(4.13±0.91)分;工作岗位、最高学历、参加工作年限、职称为该院患者安全文化认知的影响因素.结论 医院管理者应在现有优势的情况下,平衡人员分配,将人力资源向工作压力大、任务繁重的科室倾斜,营造非惩罚文化氛围,保障患者安全.

Objective:To evaluate the efficacy of transgastric combined with percutaneous endoscopic treatment for infected pancreatic necrosis (IPN).Methods:Clinical data of 19 IPN patients who received transgastric combined with percutaneous endoscopy at the Gastroenterology Intensive Care Unit of Nanjing Drum Tower Hospital from August 2015 to August 2020 were retrospectively studied. The clinical efficacy and the procedure-related complications were analyzed.Results:The mean procedure of endoscopic transmural drainage (ETD) was 1.1±0.3 times. During ETD procedure, lumen-apposing metal stents (LAMS) were placed in 9 patients, metal coated stents in 2 patients, double pigtail plastic stents in 7 patients, and only a nasal cyst drainage tube in 1 patient. All 19 patients received 12-14 F drainage catheters for drainage during the first percutaneous catheter drainage (PCD) treatment with the mean number of catheters of 1.8±1.2. Double cannulas was subsequently replaced in 3 of them for continuous drainage, and a percutaneous metal coated stent was replaced in 1 patient. The culture results of drainage fluid were 11 cases of gram-negative bacilli and gram-positive cocci, 4 cases of gram-positive cocci, 1 case of gram-positive bacilli, 3 cases of gram-negative bacilli. Among 19 patients, 4 cases had concurrent fungal infections. The mean number of debridement was 3.1±1.8 times, 2 cases of which were treated with endoscopic transluminal necrosectomy combined with percutaneous endoscopic necrosectomy. The mean procedure per patient was 6.1±2.4 times. Bleeding occurred in 1 case (5.3%) after the operation. But the bleeding was successfully stopped after endoscopic hemostasis. No serious complications such as gastrointestinal fistula, perforation or pancreatic fistula occurred. One patient died due to sepsis, and 18 other patients showed significant absorption of IPN after the treatment. None of the 19 patients were transferred to laparotomy.Conclusion:Transgastric combined with percutaneous endoscopic approach is safe and effective for IPN.

目的:探究江苏省某三甲医院职工患者安全文化的态度、认知及行为的现状,为医院进一步展开患者安全研究提供数据资料和支持.方法:以医院患者安全文化问卷(HSOPSC)为调查工具,通过问卷调查法、简单随机抽样法,共收回有效问卷779份.对基本情况采用描述性统计,对不同特征研究对象的认知现状进行方差分析,对影响认知的各维度关系运用相关性分析,针对患者安全文化的影响因素运用多重线性回归分析,以P＜0.05作为差异有统计学意义.结果:该院职工的总体平均得分为(4.13±0.91),"新事物在医疗过程中的管理和使用""对错误的反馈和沟通""管理者对患者安全的支持"等九个维度为优势维度;"人员配置""开放性沟通""对错误的非惩罚性反应"等为弱势领域.结论:该院患者安全文化位于中等水平,仍有待改进之处,如存在管理者患者安全理念与医院实际运行情况冲突、开放性沟通存在困难、职工害怕惩罚等问题.

探讨院长行政查房管理现状,通过优化规范查房流程、跟踪落实情况、完善信息平台、建立反馈机制、创新查房内容等改进措施,提高院长行政查房效率,推动行政查房向规范化、系统化、科学化发展,提升医教研品质内涵,推动学科建设,不断提升医院精细化管理水平,助力医院高质量可持续发展.

阐述Kano模型的理论及应用方法,综述其在国内护理管理实践中的总体应用情况,包括应用现状、现有研究方向及应用思路等,并基于研究现状从研究设计方法多元化、管理工具系统化联合应用发展、动态管理服务对象需求、及时应对社会环境变化、扎实管理工具的理论基础研究等方面进行展望,以期推广Kano模型在护理管理中的研究发展,同时为后续研究提供借鉴参考.

Objective:To evaluate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) for the elderly patients (80 years or older) with choledocholithiasis.Methods:A retrospective study was conducted on 742 cases of choledocholithiasis who underwent ERCP at Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School from January 2014 to December 2017. The patients were divided into two groups: 196 patients aged 80 or above (the very elderly group) and 546 patients aged 60 or below (the non-elderly group). The baseline data including gender, number and size of stones of the two groups were matched using the 1∶1 propensity score matching, and the covariate equalization samples between the two groups were obtained and 196 pairs of patients were successfully matched. The treatment success rate, complication incidence, hospitalization time and cost were analyzed.Results:Comorbidities in patients of the elderly group were significantly more than those in the non-elderly group [93.4% (183/196) VS 76.5% (150/196), P<0.001]. The success rates of treatment were 96.4% (189/196) and 96.9% (190/196), respectively ( P=0.778). The incidence of postoperative complications were 8.7% (17/196) in the elderly group and 6.6% (13/196) in the non-elderly group ( P=0.447). The mean hospitalization time and the mean hospitalization cost of the elderly group and the non-elderly group were 8.20 days, 23 624.06 Yuan and 8.03 days, 22 249.64 Yuan, respectively (all P>0.05). Conclusion:ERCP is effective and safe, and can be used as the first choice for senile patients with choledocholithiasis.

目的 了解医院质量管理组织设置、职能范围、影响因素等,为下一步工作改进提供参考.方法 采用问卷调查法,从组织架构、人员结构、管理职能、工具应用与激励措施、影响因素5个方面调查医院质量管理组织结构.结果 不同形式下质量管理组织人员组成以及部分管理职能比较具有统计学意义(P＜0.05);品管圈与追踪评价法在质量管理中应用较广泛,且95.31％的医院采取了激励措施;影响因素的重要性与现状满意度不对等.结论 医院应建立结构合理、功能定位明确的质量管理组织体系,加强复合型人才培养,进一步推动质量管理信息系统建设,并积极推进质量管理工具应用.

The severe acute respiratory virus coronavirus 2 (SARS-CoV-2), the etiological pathogen of coronavirus disease 2019 (COVID-19), is spreading in the world. There is currently no specific treatment f...

Journal of Medical VirologyVolume 92, Issue 10 p. 1779-1781 LETTER TO THE EDITOR Possibly critical role of wearing masks in general population in controlling COVID-19 Guangshu Han, Guangshu Han Department of Internal Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, ChinaSearch for more papers by this authorYi-Hua Zhou, Corresponding Author Yi-Hua Zhou [email protected] orcid.org/0000-0001-8880-0392 Departments of Laboratory Medicine and Infectious Diseases, Nanjing Drum Tower Hospital and Jiangsu Key Laboratory for Molecular Medicine, Nanjing University Medical School, Nanjing, Jiangsu, China Correspondence Yi-Hua Zhou, MD, PhD, Departments of Laboratory Medicine and Infectious Diseases, Nanjing Drum Tower Hospital, 321 Zhong Shan Road, Nanjing, 210008 Jiangsu, China. Email: [email protected]Search for more papers by this author Guangshu Han, Guangshu Han Department of Internal Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, ChinaSearch for more papers by this authorYi-Hua Zhou, Corresponding Author Yi-Hua Zhou [email protected] orcid.org/0000-0001-8880-0392 Departments of Laboratory Medicine and Infectious Diseases, Nanjing Drum Tower Hospital and Jiangsu Key Laboratory for Molecular Medicine, Nanjing University Medical School, Nanjing, Jiangsu, China Correspondence Yi-Hua Zhou, MD, PhD, Departments of Laboratory Medicine and Infectious Diseases, Nanjing Drum Tower Hospital, 321 Zhong Shan Road, Nanjing, 210008 Jiangsu, China. Email: [email protected]Search for more papers by this author First published: 15 April 2020 https://doi.org/10.1002/jmv.25886Citations: 9Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. REFERENCES 1 The World Health Organization. Coronavirus disease 2019 (COVID-19) situation report–82. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200411-sitrep-82-covid-19.pdf?sfvrsn=74a5d15_2. Accessed April 12, 2020. Google Scholar 2Feng S, Shen C, Xia N, Song W, Fan M, Cowling BJ. Rational use of face masks in the COVID-19 pandemic. Lancet Respir Med. 2020; 8(5): 434–436. https://doi.org/10.1016/S2213-2600(20)30134-X 10.1016/S2213-2600(20)30134-X CASPubMedWeb of Science®Google Scholar 3Leung CC, Lam TH, Cheng KK. Mass masking in the COVID-19 epidemic: people need guidance. Lancet. 2020; 395(10228): 945. https://doi.org/10.1016/S0140-6736(20)30520-1 10.1016/S0140-6736(20)30520-1 CASPubMedWeb of Science®Google Scholar 4 WHO. Coronavirus disease (COVID-19) advice for the public: when and how to use masks. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks. Accessed April 12, 2020. Google Scholar 5Ma QX, Shan H, Zhang HL, Li GM, Yang RM, Chen JM. Potential utilities of mask-wearing and instant hand hygiene for fighting SARS-CoV-2. J Med Virol. 2020. https://doi.org/10.1002/jmv.25805 10.1002/jmv.25805 Web of Science®Google Scholar 6He G, Sun W, Fang P, et al. The clinical feature of silent infections of novel coronavirus infection (COVID-19) in Wenzhou. J Med Virol. 2020. https://doi.org/10.1002/jmv.25861 10.1002/jmv.25861 Web of Science®Google Scholar 7Lu S, Lin J, Zhang Z, et al. Alert for non-respiratory symptoms of coronavirus disease 2019 (COVID-19) patients in epidemic period: a case report of familial cluster with three asymptomatic COVID-19 patients. J Med Virol. 2020. https://doi.org/10.1002/jmv.25776 10.1002/jmv.25776 Web of Science®Google Scholar 8 Korean Society of Infectious Diseases; Korean Society of Pediatric Infectious Diseases; Korean Society of Epidemiology; Korean Society for Antimicrobial Therapy; Korean Society for Healthcare-associated Infection Control and Prevention; Korea Centers for Disease Control and Prevention. Report on the epidemiological features of coronavirus disease 2019 (COVID-19) outbreak in the Republic of Korea from January 19 to March 2, 2020. J Korean Med Sci. 2020; 35(10):e112. https://doi.org/10.3346/jkms.2020.35.e112 10.3346/jkms.2020.35.e112 PubMedWeb of Science®Google Scholar 9Greenhalgh T, Schmid MB, Czypionka T, Bassler D, Gruer L. Face masks for the public during the COVID-19 crisis. BMJ. 2020; 369:m1435. https://doi.org/10.1136/bmj.m1435 10.1136/bmj.m1435 PubMedGoogle Scholar 10Zhou ZG, Yue DS, Mu CL, Zhang L. Mask is the possible key for self-isolation in COVID-19 pandemic. J Med Virol. 2020. https://doi.org/10.1002/jmv.25846 10.1002/jmv.25846 Web of Science®Google Scholar Citing Literature Volume92, Issue10Special Issue on New coronavirus (2019‐nCoV or SARS‐CoV‐2) and the outbreak of the respiratory illness (COVID‐19): Part‐VIOctober 2020Pages 1779-1781 ReferencesRelatedInformation

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is now overwhelming spreading in the world. As of April 11, 2020, totally 1.61 million COVID-19 patients were confirmed in more than 200 countries and regions with 99690 deaths. This article is protected by copyright. All rights reserved.

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">第三方机构主导的远程健康咨询体系是一个复杂适应系统。在外部政策的支持和规定下,体系以第三方机构为核心,其他多元主体共同参与。多种要素在系统内不断交换和互动,共同促进系统向更高级的方向演化。本文以复杂适应系统理论中的聚集、多样性、非线性、流、标识、积木块和内部模型概念为基础,分析第三方机构主导的远程健康咨询体系中的参与主体、政策机制、筹资机制和流程机制,据此提出具体的政策建议,以促进第三方机构主导的远程健康咨询体系的良性发展。</span>

The outbreak of coronavirus disease 2019 (COVID-19) characterized with pneumonia, firstly occurred in Wuhan city, China, in December 2019 has so far spread in over 200 countries and territories in the world. One of the important goals in facing outbreaks of COVID-19 is to reduce the case fatality rate. We reported here that the fatality rate of COVID-19 in other provinces of mainland China was 0.82% (121/14,708), significantly lower than 6.62% (4512/68,128) in Hubei province (p<0.0001). The main reason for the lower fatality rate was likely due to the timely management of the patients in other provinces, highlighting the importance of timely management of patients in reducing the fatality rate of COVID-19.

目的:以江苏省为例,了解新冠肺炎疫情对公立医院远程医疗发展情况的影响及医务人员对医院远程医疗建设的需求.方法:运用分层抽样法抽取样本,对样本医院及其医务人员进行访谈和问卷调查,对结果进行描述性统计分析和分层卡方检验.结果:江苏省公立医院远程医疗建设水平在疫情前和疫情期间变化有差异,苏北、苏中、苏南3个地区建设水平有差异.医务人员对所在医院远程医疗建设的满意度较高,对远程医疗建设需求主要集中在制度优化和硬件设备完善两个方面.结论:新冠肺炎疫情推动了江苏省公立医院远程医疗的发展,但省内不同地区建设水平存在差异,应在平衡地区发展水平的基础上,以制度建设、硬件设备性能提升等为重点,持续推进公立医院远程医疗建设.

目的 结合我国新型冠状病毒肺炎疫情的防控工作,建立医院应对突发公共卫生事件应急管理体系,为全国疫情防控和公共卫生应急管理体系构建提供参考.方法 参考国内外重大疫情等突发公共卫生事件管理的文献,结合南京大学医学院附属鼓楼医院等医院在新冠肺炎疫情防控中的实际做法,梳理医院应对新型冠状病毒肺炎等突发公共卫生事件3个阶段要求及管理重点.结果 建立了突发公共卫生事件预警识别阶段、应急处理阶段和恢复重建阶段3个阶段的医院应急管理重点,并构建了组织指挥体系、专家救治体系、培训防控体系、综合管理体系、人员调度体系、物质保障体系、信息保障体系、关怀激励体系、科研攻关体系、宣教引导体系等10个方面的医院应对新型冠状病毒肺炎等突发公共卫生事件应急管理体系.结论 构建全方位、立体化、多层次和综合性的医院公共卫生应急管理体系,是一个综合性、专业性、系统性强的复杂工程,必须高度重视,常态化运行,多方联动,持续完善.

Background Chest pain center (CPC) accreditation plays an important role in the management of acute myocardial infarction (AMI). However, no evidence shows whether the outcomes of AMI patients are improved with CPC accreditation in China. Methods and Results This retrospective analysis is based on a predesigned nationwide registry, CCC‐ACS (Improving Care for Cardiovascular Disease in China‐Acute Coronary Syndrome). The primary outcome was major adverse cardiovascular events (MACE), including all‐cause death, reinfarction, stent thrombosis, stroke, and heart failure. A total of 15 344 AMI patients, from 40 CPC‐accredited hospitals, were enrolled, including 7544 admitted before and 7800 after accreditation. In propensity score matching, 6700 patients in each group were matched. The incidence of 7‐day MACE (6.7% versus 8.0%; P=0.003) and all‐cause death (1.1% versus 1.6%; P=0.021) was lower after accreditation. In multivariate adjusted mixed‐effects Cox proportional hazards models, CPC accreditation was associated with significantly decreased risk of MACE (hazard ratio: 0.78; 95% CI, 0.68–0.91) and all‐cause death (hazard ratio: 0.71; 95% CI, 0.51–0.99). The risk of MACE and all‐cause death both followed a reverse J‐shaped trend: the risk of MACE and all‐cause death decreased gradually after achieving CPC accreditation, with minimal risk occurring in the first year, but increased in the second year and after. Conclusions Based on a large‐scale national registry data set, CPC accreditation was associated with better in‐hospital outcomes for AMI patients. However, the benefits seemed to attenuate over time, and reaccreditation may be essential for maintaining AMI care quality and outcomes.

远程会诊是推动优质医疗资源下沉、解决老百姓"看病难、看病贵"问题的重要举措.本文在介绍远程会诊平台的发展背景和现状问题的基础上,构建了以区域远程会诊管理中心为会诊双方信息传递和管理中介的区域远程会诊平台,介绍了该平台的运行机制,并有针对性地提出完善我国区域远程会诊平台建设的建议,促进优质医疗资源的流动,降低患者的看病成本,提高医疗服务的质量和效率.

Objective To provide reference for promoting the construction of telemedicine and improving the quality of telemedicine services.Methods Based on the "structural-process-result"quality framework, the research progress of telemedicine practice and effect evaluation at home and abroad was reviewed. Results Telemedicine helped optimize the accessibility of health resources and the coordination of medical services, improve the efficiency of medical service delivery system, improve patient satisfaction, and control medical expenses.However, the quality of telemedicine services needed to be comprehensively evaluated and controlled. Conclusion In the construction of telemedicine, especially in the process quality control, it is necessary to continuously promote standardization.

目的 依据对医疗新技术的理解及对目前医疗新技术开展所面临的问题,研究建立某三级综合医院医疗新技术的评价指标体系.方法 采用德尔菲法、专家问卷咨询法完成评价指标的各级维度和条目的筛选,层次分析法分析评价指标权重系数,确定各级指标的权重.结果 问卷回收率为100％,专家权威系数均在0.85以上;专家协调系数进行肯德尔和谐系数检验,结果可信(P<0.05);最终确认4个一级指标、19个二级指标.结论 构建的医疗新技术评价指标体系能够满足新技术评价体系的基本要求,为解决目前医疗新技术评估面临的问题提供了解决办法.

在推进与高淳人民医院的医联体建设过程中,南京鼓楼医院先后采用了专科联盟、科室托管、建设分院、全面对接等工作模式,利用现代医院管理思路、项目管理推进工作方法,建设了一种新的医联体帮扶“高淳模式”.这种模式的医联体实践,其多种管理模式并存,项目管理、目标管理、流程管理等管理细节层出不穷,不仅使基层医疗机构能够“接得住”;同时也提高了群众对优质医疗资源的“近距离”获得感,医务人员的劳动、帮扶医院的利益均得到了不同程度的反馈.

医疗技术可以说是凝聚着医务人员智慧的结晶,由于临床工作存在很多不确定的风险,如不加强监管,临床科室随意开展各种医疗新技术,很可能对患者的生命安全造成一定的安全隐患,甚至影响医院的声誉.新技术管理是医疗技术规范化管理的重要内容之一,其主要内容包括技术准入、过程控制、效果评价、安全管理、伦理把握等方面.医疗技术的管理是一项经常性工作,既需要常抓不懈,更需要与时俱进.一方面开展医疗新技术给医疗机构、医务人员带来技术进步、声誉和经济上的获益,另一方面开展医疗新技术作为一种创新性实践,具有探索性特征,因此,进行系统规范的管理,不断探索医疗新技术应用管理的理论和制度体系,在促进医疗新技术的健康发展的同时,维护患者健康安全,是非常有必要的[1].