我国每年有10万例染色体异常疾病的新生儿出生,给家庭及社会造成严重的负担.产前筛查是预防出生缺陷的有效手段,规范产前筛查及产前诊断工作十分迫切.目前产前筛查工作面临筛查率低、筛查不规范、筛查后的后续处理不规范等问题,通过以问题为导向的教学方法 ,使医学生能够将理论与实践紧密结合,有利于产前筛查工作的规范化.

某院探索应用6S管理工具进行医技科室精细化管理.首先全员普及6S精益管理理念,形成6S专项管理小组、制定过程管理和效果管理考评指标、操作流程及考评制度,之后结合医院自身特点按照整理、整顿、清扫、清洁、素养、安全6要素全面提升医技科室管理质量.在过程中严格按照6S管理步骤实施,创新性设计过程管理和效果管理考评指标体系,注重细节管理.经过2018年1月1日-2019年12月31日2年的实施,医院医技科室绩效考核成绩有不同程度提高,大于85分以上的科室数量从66.67％提升至77.78％.通过6S改进项目及评比等手段,医疗质量获得提高、效率提升,患者安全更有保障.说明6S管理工具是医技科室精细化管理的有效手段.

目的:调查了解北京石景山地区人工流产情况以及避孕失败的相关因素.方法:随机整群选取2018年1月-2020年1月北京石景山地区部分计划生育服务机构共5766例人工流产女性,问卷调查并分析人工流产妇女基本情况及避孕失败的影响因素等.结果:发放调查问卷5766份,回收有效问卷5687份,有效问卷回收率为98.6％.5687例被调查对象年龄(33.3±3.4)岁(14～49岁),其中≤20岁14.3％、21≤30岁32.0％、31～40岁45.6％、＞40岁占8.1％.教育背景以高中/中专(21.5％)和初中及以下(69.3％)居多,职业以无业(34.0％)、农民(30.8％)占比较高;已婚占68.5％、未婚占27.4％、离异4.1％.避孕失败(61.2％)是导致非意愿妊娠主要因素;64.7％有既往生育史,18.9％有过1次既往流产史,49.4％有≥2次流产史.已生育女性主要采用宫内节育器避孕(43.2％),未生育女性主要采用安全套避孕(47.5％),避孕方式有差异(P＜0.05).多因素logistic回归分析显示,不掌握避孕知识、无业或农民、初中及以下教育背景、避孕方式使用不当是导致避孕失败的独立风险因素(P＜0.05).结论:北京石景山地区人工流产女性以低教育背景、无业或农民、已婚等占比最高,不掌握避孕知识、教育背景、职业、避孕方式不当是导致避孕失败的主要因素.应强化该地区育龄女性避孕知识宣教工作,以降低人工流产发生.

论述器官移植伦理委员会国内外现状,探讨引进国际伦理委员会认证,使伦理委员会的审查流程和内容标准化,提高器官移植伦理审查的质量与效率.为了促进器官移植伦理委员会权利和义务更好的执行,相关部门应成立专门监管机构对医院器官移植伦理委员会进行监督管理.结合医院器官移植伦理委员会实际工作,器官移植伦理委员会应从引进医院伦理认证,规章制度建设、组织和人员构成等方面进行规范化建设,并对规范化审查重点内容、知情同意书及某院实际审查工作中不断梳理和完善审查内容进行阐述,旨在确保临床规范开展捐献和移植工作,促进医院提高医疗质量,保障患者合法权益,防范医疗风险方面发挥积极作用.

Medication errors have become a serious public health problem. Elderly patients have the highest incidence of medication errors. The risk factors of medication errors in elderly patients include suffering from more co-existing diseases, multiple drug use (including high-alert drugs), liver and kidney dysfunction, cognitive impairment, and living alone. The common types of medication errors in elderly patients include drug omission, failure to take medicine according to the scheduled time, wrong medication method, repeated medication due to forgetting, over dose medication, mistakenly taking drugs prohibited to be taken at the same time, and etc. Clinicians and pharmacists should participate in the medication management in the elderly patients together. Clinicians should strengthen communication with patients when prescribing prescriptions and pharmacists should strengthen the prescription review, so as to improve their medication compliance. It is suggested that medication education in the elderly patients should be patiently carried out with oral and written forms, electronic equipment could be used to help remind elderly patients of medication, and the family members of elderly patients with memory impairment should be asked to participate in the medication management.

[目的]探讨回授法健康教育对妊娠期糖尿病(GDM)患者认知、遵医行为及母婴预后的影响.[方法]选择2016年1月至2017年12月于本院定点产检的106例GDM患者,采用随机数表法将其分为观察组(回授法健康教育)与对照组(常规健康教育),每组53例.干预12周后,比较两组患者疾病知识的水平、遵医行为及血糖指标变化和母婴结局情况.[结果]干预12周后,观察组疾病知识知晓率、健康行为依从性明显高于对照组(P＜0.05).观察组空腹血糖、餐后2h血糖、糖化血红蛋白水平明显低于对照组(P＜0.05).观察组妊娠高血压、晚期流产、早产、产后出血、产褥感染发生率明显低于对照组(P＜0.05).[结论]回授法健康教育可增强GDM患者疾病认知水平,提高遵医行为,有助于改善血糖控制效果,从而改善母婴预后.

为了提升患者就医体验,减少异地患者因出院结算等待造成的时间及费用成本,北京市某三级甲等医院在异地医保患者跨省就医住院费用直接结算运行平稳的基础上,分析传统出院结算流程中存在的问题,通过加强医护人员自查能力、完善信息系统功能等措施多环节优化流程,在全市率先实现了异地持卡患者出院当日结算,目前成效显著,异地医保持卡患者平均结算时间从3.3天缩短到0.4天.下一步医院将依托智能化信息系统,持续为患者提供更加便捷的优质服务.

目的 评价医院学科建设医疗工作评估模式的有效性,带动学科医疗工作不断进步.方法评价2018年某院学科建设,设定医疗工作量与效率、医疗水平与质量两个二级指标,12个三级指标,从"临床工作效率、临床诊疗声誉、诊疗新技术开展、医疗质量与安全"四个维度出发,对24个有病房的临床科室进行评价.结果学科建设中医疗工作分值为250分,平均分值为162.83,最高分值为193.36,最低分值为121.36,国家临床重点专科科室分列第一、第二位.结论从2018年各指标平均分值来看,指标设定较客观全面,维度合理,还需要进一步应用管理工具,动态监测,力求客观真实,科学有效.

检验结果对临床治疗方案的选择起着至关重要的作用.通过1例检验结果发布错误事件,运用根本原因分析法,确认事件发生的根本原因,找到错误发生的系统因素,制定针对性改进措施,提升和完善系统,保障患者安全.

妇产科住院医师规范化培训是优秀妇产科医生成长的必经之路. 优秀的妇产科住院医师应具备较高的人文修养,善于处理医患关系;能了解妇产科疾病的相关基础知识,熟练掌握妇产科的基本操作,胜任常规手术;具有良好的逻辑思维与发散思维,将理论知识与临床实践相结合[1,2]. 故本文对妇产科住院医师规范化培训的重要性,妇产科住院医师人文修养、临床技能、临床思维的培养和妇产科住院医师考核等方面总结如下.

病理报告是疾病诊断的重要医学文书,能够帮助临床医师确定诊断、明确分型,为临床诊疗提供证据支持,是保障医疗质量与患者安全的重要依据,同时也是病案的重要组成部分.本文通过回顾性分析某院已上报的病理报告错误相关不良事件,确定了目前某院病理报告错误的主要原因是在病理申请、送检、接收、处理以及报告发布等各环节中未严格执行医疗规章制度.由此,为提高病理报告质量和病案质量,医院和科室一方面应建立完善的制度体系,并通过培训保障制度的有效落实;另一方面应健全质量控制体系,加强对运行质控和终末质控的管理,并对关键环节进行重点警示,形成关键环节重点警示的工作形式.

本文阐述了器官移植伦理委员会审查现状、审查原则、目的、意义及审查的重点内容,提出建立符合我国国情的器官移植伦理委员会规范化审查标准势在必行,以确保患者在移植过程、医疗质量与安全的权益.器官移植病历书写反映器官移植技术临床应用的整个治疗过程,因此器官移植伦理委员会规范化审查对病案书写提出了更高的要求.进一步从病案质量,病程记录,知情同意书,医师资质等方面伦理审查要求进行了阐述,列举了病程记录及知情同意书中常见的问题,并提出加强病历书写人员对器官移植法律、法规、制度等知识培训和加强病案质量控制等改进措施,从而为器官移植伦理委员会规范化审查病历书写提供参考.

现代科学技术的不断进步带动了医学新技术的发展,内镜技术在妇科临床治疗的广泛应用,推动了妇科诊疗的进步.随着内镜技术的在全国范围的普及,妇科内镜医师的专业化培训显得尤为重要,全国范围内建立了若干个内镜技术培训基地,相关培训课程、学习班遍及全国各地.文章就妇科内镜培训基地质量管理进行了探索性思考,并提出相关建议.

Objective To explore the value of the 36-Degree feedback method in the evaluation of surgical resident training. Methods The professional ethics, communication skills, as well as the clinical competence of 30 surgical residents from our university hospital were evaluated by their clinical teachers, nurses and themselves, using a 360-degree feedback method. The differences and correlation from three groups of estimators were explored. And the clinical competence was compared with the routine departmental rotation examination score. Results No statistical difference (P=0.053) or correlation (r=-0.03, P=0.88; r=0.30, P=0.11; r=-0.13, P=0.49) was found in the evaluation of professional ethics of the residents by clinical teachers, nurses or themselves. In the evaluation of communication skills, the results from the three groups were similar (P=0.66); the evaluation by nurse was not correlated with that by the clinical teachers or themselves (r=0.16, P=0.41; r=-0.04, P=0.85); while the evaluation by the clinical teacher was correlated with that by the residents themselves (r=0.49, P=0.01). The evaluations of clinical competence by the clinical teachers were statistically correlated with routine departmental rotation examination score (r=0.45, P=0.01). The professional ethics and communication skills were not statistically correlated with the routine departmental rotation examination score (r=0.29, P=0.12; r=0.34, P=0.07). Conclusion The evaluation of professional ethics of the residents by the clinical teachers, nurses or themselves could not be replaced by each other. The evaluation of communication skills of the residents by their clinical teachers could reflect that by themselves, but not by the nurses. Although the results of the clinical competence evaluated by the clinical teachers were similar to routine departmental rotation examination scores, both of them could not replace the evaluation of the professional ethics or communication skills. As a result, the 360-degree feedback method was found to be able to conduct a more comprehensive and effective evaluation of the residents than the routine way and has a wide range of applications in medical education and training.

情景模拟教学是利用角色扮演和临床情景来进行临床教学的一种教学方法,倡导以贴近临床的真实环境开展教学,培养医生在病情动态变化中的把控和应对,特别适用于产科教学.选择产科常见病、多发病作为模拟案例,课前宣布训练主题,学生课前自行复习相关知识.制定模拟教学目标及程序,将典型的症状及体征设计在模拟过程中,由住院医师查体,主动获得患者体征信息,并决定处理方案.文章介绍情景模拟教学在产科住院医师培训中的应用过程,包括具体的病案设计、情景演练及评价方法,同时分析了使用经验及存在的问题,并对今后产科有效推进模拟教学在住院医师培训中的应用提出了建议.

目的 研究促性腺激素释放激素激动剂(GnRHa)联合左炔诺孕酮宫内缓释系统(LNG-IUS,商品名:曼月乐)治疗子宫腺肌病的临床疗效.方法 选择2014年7月至2016年7月于首都医科大学附属北京妇产医院就诊的31例子宫腺肌病患者为研究对象,GnRHa治疗3个月后放置LNG-IUS,观察治疗前及放置LNG-IUS后1个月、3个月、6个月、12个月的痛经程度、月经情况、血红蛋白变化及子宫体积.结果 28例子宫腺肌病患者完成了治疗及随访.28例患者GnRHa治疗后3个月均无月经来潮,无痛经.放置LNG-IUS后3个月、6个月、12个月痛经视觉模拟评分法评分均显著低于治疗前(P<0.05);放置LNG-IUS后3个月血红蛋白显著高于治疗前(P<0.05).28例患者GnRHa联合LNG-IUS治疗6个月内子宫体积均明显缩小,但放置LNG-IUS后6个月子宫体积较放置LNG-IUS前稍有增大(P<0.05),放置LNG-IUS后6个月、12个月后较放置LNG-IUS 1个月后子宫体积增大(P<0.05).结论 GnRHa联合LNG-IUS治疗子宫腺肌病可有效缓解患者痛经及经量增多症状,抑制子宫体积持续增大.

Objectives This paper reviewed the characteristics of multidisciplinary joint consultation in elderly patients and provided basis for the comprehensive diagnosis and treatment of elderly patients.Methods To collect the information of multi-disciplinary joint consultation of elderly patients from 2015 to 2016, and analyze the characteristics of multidisciplinary consultation in elderly patients. Results There were 130 cases of multidisciplinary joint consultation in elderly patients in the hospital, accounting for 48.88 percent of the multi-disciplinary consultation in the hospital. A total of 640 subjects participated in the consultation. A total of 62 cases(including 22 patients) were diagnosed and 50 cases were discussed before the operation. The largest number of applications for consultation was orthopaedic department. The department that has been invited to the most visits is the cardiology department.Conclusions The elderly patient had a high proportion of multidisciplinary joint consultation, which was mainly based on the patient consultation in perioperative period. The multi-disciplinary joint consultation would provide support for the further strengthening of perioperative management of elderly patients and improve the quality of medical care.

文章从组织架构、管理体系、就医流程、资源共享、考核与激励机制等方面对紧密型医联体医管理模式进行了探讨,认为在新政策形势下,创新医联体管理模式,建立医联体保障机制,对于推进紧密型医联体建设和发展具有重要意义.

一般来说,排卵日是下一次月经来潮前的第14天.但是这种方法只适合月经规律的女性.由于排卵期会受疾病、情绪、环境、药物的影响而发生改变,所以需要与其他方法结合使用. 观察白带拉丝每个经期结束以后的几天,会出现白带现象.排卵期,子宫颈开启,子宫分泌的黏液水分增加,白带排量增多,变得清亮润滑而富有弹性,如同蛋清样,拉丝度高,不易拉断.