公立医院绩效考核的改革是医药卫生体制改革的重点.从医院管理、科室管理、医院员工3个层面总结我国公立医院绩效评价体系现状,并分析公立医院构建绩效评价体系常用的技术和方法,指出我国公立医院绩效评价体系存在欠缺反映社会公益性的绩效评价指标、绩效评价主体单一化、绩效指标的筛选与考核标准的制定缺乏科学性等问题.在建立绩效评价体系时,应注意指标的筛选,兼顾公益性指标和经济类指标,绩效评价主体应多元化,根据不同科室、岗位的特点建立科学、规范的公立医院绩效评价体系.

The medical record duplication by EMS delivery to the hands of patients is the unanimous desire of patients, patients on the day of discharge or apply to the competent physician in the hospital medical record, fil in application, and by a competent physician review of their identity, to record room for duplication the medical record courier service, address and telephone number are provided in accordance with record duplication applicants may complete the record duplication service work. The method, reduces the field with time and economic burden of travel, but also protects the privacy of patients, and improves the work ef iciency and the duplication of the writing quality of medical records; improve medical record management level of service, patient satisfaction is also greatly improved.

目的：探索武汉市颅脑损伤儿童的性别、年龄、损伤原因特征,为未来的预防措施提供依据。方法以2011年1月至2013年7月武汉市儿童医院住院的颅脑损伤患者为研究对象,采用描述性分析方法,分析颅脑损伤儿童的性别、年龄及损伤原因的特征,对比分析不同年份之间的受伤原因构成比差异。结果患者男女比例1.79：1；0~3岁占62.4%,1岁以下最多(31.6%)；损伤原因中跌落/跌倒占73.2%,车祸占16.0%,3岁以下与3岁及以上儿童的损伤原因构成比差异有统计学意义,不同年份之间损伤原因构成比差异无统计学意义。结论儿童颅脑损伤的发生存在一定的规律性,近几年损伤原因未发生显著改变,可根据其规律性和原因制定相应的防范措施,有效降低儿童脑损伤的发生。

Objective To investigate behavioral problems in children with obstructive sleep apnea hypopnea syndrome(OSAHS),so as to provide scientific basis for psychological health education and ensure children's physical and mental health.Methods A total of 28 children aged from 6 to 12 years were selected from the department as the OSAHS group and another 28 healthy children were chosen as the control group.Results The scores of OSAHS children in social withdrawal,body complain,aggression and hyperactivity were significantly higher than the healthy group(P0.01 or P0.05).Conclusion Compared with the healthy children,the OSAHS children have certain behavior problems.It's essential to give psychological and behavioral intervention to the children with OSAHS.

目的 探讨武汉地区中医发展综合效益状况方法 选取20个指标组成指标体系,采用主成分综合评价法,对武汉地区2003-2008年的中医发展现状进行综合评价研究结果 中医人员构成比、中医高级职称人员构成比、中医本科以上人员构成比、中医住院量构成比、中医治疗有效率、中医病床使用率、中医病床周转次数、职工人均业务收入、每床日平均收费水平、每职工平均完成住院床日数、中医重点专科数以及中医每床位占用固定资产等指标在第一主成分上有较高的载荷,说明第一主成分基本反映了这些指标的信息;每出院人次平均住院业务收入在第二主成分上有较高载荷,说明第二主成分基本反映了这类指标的信息,所以提取的2个主成分可以基本反映全部20个指标的信息.2003-2008年武汉地区中医发展态势良好,并能从综合得分中看出医疗质量的提高程度,2008年为最高,排名情况依年份往前推,以2003年为最低结论 中医发展的主要决定因素有中医人员队伍建设状况、中医住院床位工作效率、中医职工工作效益及中医学科发展水平等,各大医院要寻求中医事业的发展,必须从以上几方面着手搞好中医建设发展工作,促进中医事业的进一步提高.

目的 了解利用病种管理实施绩效经营的效果,探讨可行方案. 方法 利用某院2002-2006年病案首页数据及统计报表数据,对利用病种管理实施绩效经营的现状进行分析. 结果 单病种及其他病种人数占有比例较大,但增长幅度不大,专科病及疑难病种病人数占有比例较低,但增长幅度非常大.所有病人病种费用中,专科病人费用增长最快.非手术病人费用受人均药品费、人均治疗费、人均化验检查费影响较大,手术病人费用受人均药品费、人均治疗费、人均化验检查费、人均手术费影响较大,均呈正相关关系. 结论 利用病种管理实施绩效经营还需大胆探索最佳途径,从而真正体现减轻患者的医疗负担、提高医疗质量的本质上来.

通过我院网络数据管理的实践,描述网络数据管理过程中取得的成绩及存在的问题,并通过各类问题产生的原因进行分析,最终为加强网络数据管理提供依据,为医院网络化建设再上新台阶奠定基础,医院网络化管理作用也越来越显示其重要性。

With multiple applications of information resources case records,the management of information resources of case records must be standardized increasingly.The writers of the article make a study on the present situation in the standardized management of information resources of case records and the problems of organization and leadership,institution construction,managerial system,personnel quality and the quality of case record management,and suggest some countermeasures for references.

眼部手术或牵拉眼外肌时,使迷走神经兴奋性增强,加强食管和胃的蠕动,出现恶心、呕吐或腹痛等胃肠功能紊乱称眼-胃反射(oculogastvic reflex).眼-胃反射可发生在术中或术后,有时呕吐为持续性,也有术后数日不能进食,严重者可因呕吐出现脱水及电解质紊乱.

时间序列是指按时间顺序排列的随机变量,季节分析是对时间序列中由于季节性因素造成的影响进行分析的过程.

Objective To analysis retrospectively the character ot tumor distribution in 4441 cases from 1993 to 2004 in our hospital.Methods 4441 cases who were retrieved from the files of the Department of the Medical Chives which the diagnosis of tumor in the person younger than 18 years was based on the ICD-10 criteria(International Statistical Classification of Disease and Related Health Problem).To analysis the characteristics of the proportion,rank, age and gender distribution in the sorted tumors for each year and to compare them the trends alterations.Results 4441 cases were detected tumor.Male vs female was 4∶1 and malignant vs benign vs unascertained tumors were 0.24∶0.7∶0.06;the benign soft-tissue tumor was the most common tumor in childhood,of which the blood vessel tumor was at the first place.Leukemia and the cancers derived from lymphoid and myeloid resources were at the leading rank of malignant, while the neuroblastoma which derived from embryogenesis was followed.The craniocerebral and spinal tumor were the most common ones in the unascertainable or/and the under diagnosis category.The cases decreased aged up to 14 years.There was no significantly alteration of incident rate for cancers from year to year which was near the average rate(1.45%) while there has the increasing trends of the incident rates in recent years.Conclusion The type of tumor was different between children and adults.We found that carcinoids(for example,angioma which was the most common benigh tumor) were much more than malignant tumor(for example, leucoeythemia) in children,and encephalic tumor or spinal tumors were often diagnosised as unascertained one.In conclusion,tumor in children aged down to 14 years old became more than last years.

当前我国青少年的现状不容乐观,独生子女多,缺乏独立生活能力的锻炼,缺乏坚强意志的培养,吃苦耐劳、团结协作的精神和承受挫折的能力较差,成长环境因素差距的加大,从而导致青少年在生活事件方面承受种种心理及其他方面的健康问题,严重的会使青少年出现行为障碍或人格缺陷[1],所以有效地进行心理应对是预防心理问题的关键.本研究就是通过调查青少年学生的成长环境,探讨成长环境因素对青少年生活事件的影响,为促进青少年身心健康成长提供科学依据.

目的:以1993～2004年武汉市儿童医院颅脑损伤患者为研究对象,探讨颅脑损伤儿童的性别、年龄、损伤原因和预后等特征。方法:采用描述性分析方法分析颅脑损伤儿童的性别、年龄特征以及损伤原因与转归,并对颅脑损伤患者与其他损伤患者的入院情况、住院天数、住院费用和出院转归进行比较。结果:患者男孩多于女孩,男女比例为1.86:1,年龄分布主要集中在4岁以下,前3位损伤原因是跌落(67.1%)、车祸(17.6%)和挤压/撞击(10.6%);颅脑损伤患者与其他伤害患者相比预后较差,住院死亡率较高,平均住院费用较高。结论:儿童颅脑损伤的发生有一定的规律性,预后较差,给家庭和社会造成了一定的负担,可根据其损伤原因和规律制定相应的防范措施。

Objective:To analyze the seasonal distribution of injured children hospitalization.Methods:The number of hospitalized children constitute a time series,time series analysis methods-X-11 seasonal adjustment method was used to analyse seasonal factors,in order to reflect the season distribution patterns caused by different reasons of hospitalized children injury.Results:Seasonal regularity of injured hospitalized children:the peak season for all hospitalized children injury are May and September,January and February are the lowest valley,August is a lower valley.Falling was the most important reason of children injuries,and the peak value was during April to October,and the two peak in May and September;in December.January and February were the low valley.The number of hospitalized cases caused by breath obstruction was highest in February to April,and November to December,June to August is the low period of respiratory obstruction.Children transport injury hospitalization seasonality characteristic is:December,January,and February are lowest period,July is also relatively low.Cases caused by fire/burn injury were less in August,secondly was June and July.Squeeze/collision injury,incision/puncture injury hospitalization were with no obvious seasonal peak frequency.Conclusion:As a result of falling,respiratory obstruction,transportation and fire which lead to children injury with marked seasonal features,using x-11 seasonal adjustment method is effective to analyse.

医院工作质量的综合评价目前应用较多的有模糊数学综合评价方法[1],综合指数法[2],秩和比法(RSR)[3],灰色多层次综合评判法[4]等,应用这些方法进行医院工作质量的综合评价已取得了一定成果,这些方法各具特色但也存在着弊端,如模糊数学综合评价方法和灰色多层次综合评判法,对数学理论知识的要求太高,计算繁杂,不易推行.另外,一般的评价方法往往涉及到评价指标的权重,则不可避免地会带有主观性.因此,怎样使评价方法更科学和更简单是需要不断研究的课题.本文试图另辟奚径,采用主成分分析法对武汉市儿童医院近五年的工作质量进行综合评价.

目的以1993-2004年武汉市儿童医院意外伤害住院患者为研究对象,探讨伤害儿童的性别、年龄、损伤类型和损伤原因的特征.方法采用描述性分析方法,分析伤害住院儿童年龄、性别频数分布,损伤类型和损伤原因的性别、年龄特征.结果12939例意外伤害住院儿童中,损伤类型前四位是骨折、开放性损伤、软组织损伤和异物.损伤外部原因前四位依次是跌落、交通运输、呼吸道梗阻和挤压/撞击.意外损伤住院儿童男女性别比为2.1:1.0～5岁儿童占全部伤害住院儿童的66.0%;0岁组占全部伤害住院儿童的8.8%;1～2岁组占31.2%;3～5岁组占26.1%.随着年龄的增加,各年龄组患者的人数逐渐减少.结论近年来伤害正逐渐成为儿童的主要健康问题,不同性别、年龄儿童的损伤类型、损伤原因不同,应针对减少导致伤害的几种原因开展预防工作.

随着医院改革的不断深化,人们对医院护理质量的要求不断提高,护理人员的心理压力愈加增大.护理人员心理卫生状况SCL-90测试结果表明,护理人员心理卫生异常者(总分≥160)189人(43.15%),因子分≥3者主要分布于躯体化(8.8%)、焦虑(4.5%)、人际关系敏感(4.3%).影响护理人员心理健康的主要因素是社会支持度、同事关系、环境压力和本人健康状况.护理人员SCL-90总分、阳性项目数、因子分均高于中国正常人.在实施护理管理中,应主动规避影响护理人员心理健康的各种因素,变不利因素为有利因素,促进护理人员的心理健康.在相关因素调查分析中发现,护理人员选择护理专业从业,18%是自愿,41%是父母的意愿,12%是亲友的意愿,29%是无意识.偏相关分析表明,护理人员的心理压力与同事关系呈正相关性,可能与护理人员的性别及心理特征有关.

统计预测是现代医院管理工作中不可缺少的领域.它是以时间数列的历史观察值作为依据计算预测值,对未来进行统计推断,以提高医院管理工作的预见性和主动性,克服盲目性,为科学决策提供信息和依据,对于加强医院管理,合理利用人、财、物,减少工作中的盲目性,提高两个效益以及医疗质量方面均有其实际意义.

本文对武汉市儿童医院近6年来门诊量及门诊收入进行了分析,以探讨医院门诊如何适应社会医疗改革,促进医院合理创收,加强对影响门诊收入可控因素的管理,力创医院良性循环发展的氛围.

我科应用体表胃电描记法对静吸复合麻醉下,斜视手术前儿童进行了胃电活动(GMA)监测,现将观察、研究结果进行报告,以探讨麻醉对胃电活动的影响.