Objective To explore the clinical early warning index of medical risk in neurosurgical patients,and to provide evidence for establishing neurological medical risk early warning system.Methods A total of 65 patients with surgical complications from 2005 to 2015 were selected as the subjects,and 109 patients with no medical disputes were selected as control.The age,diagnosis,operation level and other information were collected from the hospital information system.21 key indicators on medical risk were screened,the Chi-square test was used for univariate analysis,and the indicators with statistical significance were further analyzed by the dichotomy logistic regression analysis.Results A total of 13 indicators,including the admission diagnosis,GCS score,etc.,showed statistically significant (P＜0.05).The logistic regression analysis showed that GCS score,complication,intracranial infection and other seven indicators were risk factors for neurosurgical medical risk.Conclusion The selected indicators are clinical indicators of neurosurgical patients,with characteristics of easy extraction,being quantified,with high sensitivity,which can provide a scientific and reliable basis for the establishment of neurological medical risk early warning system.

目的 分析和解决医学研究生存在的学术道德问题,提升医学研究生的学术道德意识,提高医学研究生的教育质量.方法 通过对现有问题进行整理归类,多角度分析原因所在.结果 原因主要有毕业就业压力比较大、利益诱惑较大、自身能力不足、缺乏有效的监督、惩处乏力、隐性产业链服务的市场化供给等.结论 医学研究生的学术道德问题形势严峻,需要多角度分析问题的存在根源,提出具有针对性、系统性的解决对策.

文章就现有对民营医院人力资源管理的研究情况进行整理和分析,从时间、文献类型、研究机构、文献主题等方面进行研究分析,探究有关民营医院人力资源管理现状,进行分析和讨论,归纳分析民营医院在人力资源管理方面存在的四大"缺口":缺人才、缺政策、缺管理和缺文化.立足于针对民营医院人力资源管理的已有研究,提出促进民营医院科学发展的思考和建议.

In order to improve the level of government governance and achieve the equalization of basic public service, it is necessary to establish a comprehensive modern hospital management system to promote scientific management and sustainable development. However, a modern hospital management system couldn’t been built without efficient governance. This article analyzes the factors of the changes of modern hospital management system from the point of view of basic governance and good governance, in order to provide theoretical support for constructing the hospital management and performing scientifi c management.

目的 对比分析手术切除与微波引导下经皮穿刺微波凝固治疗(percutaneous puncture of microwave coagulation therapy,PMCT)治疗原发性小肝癌(直径≤5 cm)患者的焦虑和抑郁状况.方法 将250例原发性小肝癌患者按照治疗方法的不同分成手术切除组(n=126)和PMCT组(n=124),应用医院焦虑抑郁量表(hospital anxiety and depression scale,HADS)对两组患者术前确诊时、术后2周、术后1月、3月、6月和9月的焦虑和抑郁状况进行对比分析.结果 两组患者均表现有焦虑和抑郁症状,但PMCT组各时点焦虑和抑郁症状发生率均低于手术切除组;两组患者术前确诊时抑郁症状评分比较,差异无统计学意义(P＞0.05);其余时点两种情绪症状比较,差异均有统计学意义(P＜0.05);PMCT组患者焦虑和抑郁症状发生率随时间的延长逐渐降低,且与术前确诊时评分比较,差异均有统计学意义(P＜0.05);手术切除组患者各时点焦虑症状发生率随时间的延长逐渐降低,抑郁发生率则先升后降,术后1月的抑郁评分与术前确诊时比较,差异无统计学意义(P＞0.05),其他时点两种情绪症状评 分与术前确诊时比较,差异均有统计学意义(P＜0.05).结论 两组患者均发生了焦虑和抑郁等情绪障碍,但PMCT组患者焦虑、抑郁症状的发生率较手术切除组低,术后情绪障碍恢复也较手术切除组快,加强临床心理干预性治疗有助于缓解患者情绪障碍,提高生命质量.

目的 比较手术切除与经皮穿刺的微波凝固消融(Percutaneous Puncture of Microwave Coagulation Therapy,PMCT)治疗肿瘤直径≤5 cm的原发性小肝癌患者生命质量.方法 应用肝癌患者生命质量测定量表(2.0版)(Quality of Life With Liver Cancer,QOL-LC-V2.0)于治疗前确诊时、治疗后2周、1月、3月、6月、9月时分别测量评价手术切除、PMCT两组患者(直径≤5 cm)的生命质量状况.结果 两组患者生命质量评分均有所降低;手术切除组生命质量的降幅较PMCT组大,各时点的生命质量评分也较PMCT组低;两组间患者治疗前的躯体功能比较差异无统计学意义(P＞0.05),其余时点各功能纬度比较差异均有统计学意义(P≤0.05);时间与组别对患者生命质量具有交互作用.结论 手术切除、PMCT均对患者生命质量造成不良影响,而PMCT不良影响程度较手术切除小,患者恢复时间短,生命质量恢复也较快.

我院(东方肝胆外科医院，东方肝胆外科研究所)是由我国肝脏外科创始人吴孟超院士，从1956年肝胆外科三人小组起步发展起来的。自2011年起，作为全军研究型医院试点单位之一，我院注重把研究型医院发展理念融入到医院的各项建设中，制定战略，创新驱动，经历了从以科技创新为主的自然发展状态，逐步通过宏观分析、系统思考，上升为主动实施管理创新、推进科技创新的自觉发展模式，有效地巩固提升了医院的核心竞争力，推动医院可持续发展[1-2]。

We analyzed and reviewed the specialty, influential factors and precaution mechanism of neuro-surgery medical risks after searching the literatures in the past few years regarding neurosurgery medical risks and precaution mechanism.For neurosurgery is one of the departments with high medical risks, the precaution system of medical risks should be established and three “key points” must be remembered.First of all, “medical risks infor-ming note” need to signed to balance the anticipation of patients.Secondly, health -care workers should imple-ment invention measures to prevent medical risks according to medical risks precaution levels.Eventually, medical personnel ought to propagate and follow up regularly.The key points mentioned above can decrease medical risks, safeguard benefits of patients and cut down the loss of medical institution.

指出住院患者跌倒的原因可能有生理因素、依从性、疾病因素、药物因素等.运用防错技术进行护理管理,采取有效措施降低患者跌倒发生率.住院患者跌倒事件由4例降低为0,提升了护理质量及患者满意度.

本文报告了肝肿瘤标本信息库建设的内容、方法和数据转化服务的应用成果,目的将研究发现带入临床诊疗,使诊断、治疗与控制方法有新的突破.通过回顾肝肿瘤标本信息库平台建设与应用过程,详细介绍了组成肝肿瘤标本信息库平台的5个专项信息系统,认为开展国际合作、顶层设计、资源整合、数据标准和数据安全是最重要的五个方面.目前已有31所医疗科研机构通过肝肿瘤标本信息库平台申请获取标本组织、临床数据、随访信息和生物信息,并将数据应用于医学基础研究和转化医学研究,均取得较好的研究成果,已发表SCI文章超过30篇.

从利益相关者理论出发,对医师多点执业进行利弊分析,并提出完善相关法律法规、深化医药卫生体制改革、强化监督管理、更新医院管理模式、加强医德医风建设等建议,以期更好地推进医师多点执业在全国范围内的贯彻落实.

对苏北某县留守群体的身体健康状况及其影响因素进行分析，发现留守群体慢性病患病率更高，经济困难是影响其健康的主要因素。为了提高农村留守群体健康水平，提出建立专项资助资金，对留守群体进行系统化管理；提供优惠政策，加强预防保健等对策措施。

医师多点执业是新医改背景下出现的新事物,学习国外先进经验对全国推广具有重要意义.国家与国家之间由于历史发展、政治制度、经济水平等因素的不同,医师多点执业的模式也不尽相同.文章就不同国家的医师多点执业进行比较研究,探索可供我国借鉴学习的路径.

在借鉴国外先进经验的基础上如何立足国情,探索一条中国特色的医师多点执业道路至关重要.文章以国家规定的三种多点执业模式为出发点,结合已有的政策,探索医师多点执业的适宜模式.

In recent year,“blood supply shortage”happened frequently in China. We should pay more attention to long-term sustainable development of blood donation without payment. There are many reasons of causing“blood supply shortage”. The particularity of blood management decides that blood donation without payment could not neither rely on market forces nor government. An effective path of governance to “blood supply shortage”should be involved by government, blood transfusion and supply service, medical institutions, NGO, news media and the society public.

Based on hospital development cycle and the core rigidities theory,the authors made a strategic analysis on the building of research-oriented hospital of the Eastern Hepatobiliary Surgery Hospital.They put forward that building a research-oriented hospital is key to exceeding the core rigidities of the hospital and promoting core competence.In their practice,they developed the model featuring innovation culture as the leader,"hospital-institute in one" as the pattern,composite talents as the core,integrated innovation as the mechanism,and high-level medical cooperation as promoter.

The connotation of translational medicine are introduced in aspects of three levels of translational research,the extension of translational medicine conception.It shows that translational medicine needs multi-disciplines cooperative research,chooses excellent project as breakthrough and strengthens its operation mode research.Problems such as lack of fund and human resources,short of research innovation and insufficient of research communication should be conquered.Suggestions such as providing more effort in the mechanism like Indemnities under the policy supporting,Medical education training,Incentives under the Innovation guiding,Two-way communication cooperation are presented.

随着社会经济发展和医药卫生体制改革的深化,我国全民医保这一目标已基本实现.新形势下,人民群众的医疗卫生服务需求增长迅速,在大型公立医院“空间失配”的情况下,“看病难”的问题依然十分严重.该文试图以公共治理为出发点,从提高医疗卫生服务的供给能力和效率的角度来讨论民营医院参与医疗卫生服务供给的公平性.

<正>二次手术是指手术过的病人进行"非计划再次手术",也就是俗称的"二进宫"[1]。近年来,随着某"三甲"专科医院手术数量不断增多,肝胆胰二次手术也明显上升,严重影响了医院的效益和患者的安全。对医院来说,存在许多环节漏洞,需要强化医疗质量管理;对患者来说,增加痛苦和费用,需要建立风险分担机制[2]。本文拟通过查阅并整理2006—2010年期间发生的223例"二进宫"手术的病例资料,从医源性角度对肝胆胰二次手术进行回顾性研究分析。

In this paper,by introducing the concept of failure mode and effects analysis(FMEA)and root cause analysis(RCA)the two methods,application,try the fusion of two ways to become an improved analysis method,discussed in orthopedic feasibility of the application and orthopedic hip replacement in the post-operative care as an example to describe the analysis steps to provide management ideasfor the orthopedic risk management.