目的 探讨在小梁咬切器辅助下泪点息肉切除术中应用丝裂霉素C的疗效.方法 选取2009年1月至2012年6月在中国人民解放军第三二二医院诊治的118例下泪点息肉患者为研究对象,将研究对象进行分组:观察组62例62眼(丝裂霉素C联合小梁咬切器辅助下泪点息肉切除术)和对照组56例56眼(小梁咬切器辅助下泪点息肉切除术).随访2 a观察并比较两组泪点息肉治疗后的临床效果及息肉复发情况.结果 术后早期观察组发生泪小点水肿17眼、角膜荧光素点染4眼,对照组发生泪小点水肿15眼、角膜荧光素点染3眼,两组并发症发生率比较差异无统计学意义(P＞0.05);两组均未发生其他严重并发症.术后随访观察2 a,观察组有效率(治愈率+好转率)为96.77％,对照组有效率为87.50％,2组差异无统计学意义(P＞0.05).观察组泪点息肉复发率为4.84％,对照组为19.64％,差异有统计学意义(P＜0.05).结论 丝裂霉素C能有效降低泪点息肉复发,提高手术成功率,值得在临床上推广.

目的:建立Ⅰ类切口手术患者使用抗菌药物合理性的评价模型,为临床药师进行处方点评提供依据.方法:以某院2017年1月1日-2017年12月31日住院的432例Ⅰ类切口手术患者作为研究对象,提取患者年龄、院内感染、使用抗菌药物的种类数等多项诊疗信息;结合临床药师对患者预防及治疗使用抗菌药物合理性的点评结果,以抗菌药物类别(预防或治疗使用)为因变量、患者诊疗信息为自变量,分别利用机器学习方法中的非条件Logistic回归法和支持向量机法,将药师点评结果转化为机器学习模型可识别的客观指标,建立Ⅰ类切口手术患者使用抗菌药物合理性的分类判别模型,并以灵敏度、特异度、约登指数等为指标,另采用61例Ⅰ类切口手术患者样本对建立的模型进行验证;收集使用模型前(人工点评,2017年1-12月)、后(2018年1-10月)Ⅰ类切口手术患者使用抗菌药物处方合理性点评情况,对模型效果进行应用评价.结果:以非条件Logistic回归法建立的模型的灵敏度为65.63％、特异度为75.00％、约登指数为40.63％;以支持向量机法建立的模型主要参数gamma为0.01、cost为10,其灵敏度为92.19％、特异度为87.50％、约登指数为79.69％,支持向量机法建立的模型优于非条件Logistic回归法;对采用支持向量机法建立的模型进行验证,结果灵敏度为100％、特异度为88.57％、约登指数为88.57％;与使用模型前比较,使用模型后处方点评比例由69.44％升高到100％,抗菌药物预防使用率由23.84％下降到16.43％,品种选用合理率由37.86％升高到54.39％,使用疗程由5.01 d缩短到3.26 d.结论:应用机器学习方法中的支持向量机法建立Ⅰ类切口手术患者使用抗菌药物的评价模型,可实现处方点评全覆盖,提高Ⅰ类切口手术患者使用抗菌药物的合理水平,同时为药师的处方点评工作提供了新思路.

Objective: To explore the characteristics of the military hospitalized patients by clustering method, and to provide better medical service for the military patients. Methods: 2038 patients admitted to a military hospital between January 2005 and June 2016 were included, K-means clustering method is used to cluster military hospitalized patients according to pseudo F statistic index, the characteristics of different types of hospitalized patients were analyzed by chi-square test and variance analysis. Results: The military hospitalized patients were clustered into six groups: normal clinic patients, patients with modality, surgery patients with high value material, simple operation patients, patients with long length of stay, patients with examination and laboratory test. There were statistical significance between the patient's age, admission form, admission conditions, number of illness, length of stay, and the total cost of six groups. Conclusion: The clustering analysis of military hospitalized patients could be used to find the problems of the military medical health service, and the suggestions were put forward to improve the quality of medical service for military patients.

Objective To investigate the change of mental health status after systematic mental health maintenance among the contract medical personnel in a military hospital.Meetotis The symptom self-assessment scale (SCL-90) was used to survey 312 contract healthcare personnel in a military hospital.Results The total average score and scores of somatization,obsessivecompulsive behavior,interpersonal sensitivity,depression,anxiety,hostility,phobe and psychosis before intervention were significantly higher than the current national norms(P＜0.05),but there was no significant difference between the score of paranoid ideationand the national norms (P＞0.05).The total average score and scores of somatization,obsessive-compulsive behavior,interpersonal sensitivity,depression,anxiety,hostility,phobe and psychosis became significantly lower after intervention (P＜0.05).Conclusion The mental health of medical staff in a military hospital can be effectively improved by applying mental health maintenance.

Objective To construct the nursing positive occupational environment,and to analyze its appli-cation effect.Methods From March 2014,the nursing positive occupational environment was constructed, including amendment of the management policy of physiological needs guarantee,development of relevant plans of safety needs guarantee,creation of reserve forces management mode for the fulfillment of social in-teraction needs,and building the humanistic environment for the fulfillment of spiritual and cultural con-sumption demands,improvement of career planning.The symptom checklist-90 (SCL-90)was used to sur-vey 203 contract nurses before and after the construction of positive occupational environment.Results After the construction of positive occupational environment,except stubborn and psychosis,the scores of other dimensions were lower than those when before the construction of positive occupational environment (P <0.05 ).Conclusions The construction of positive occupational environment is beneficial to the improvement of mental health status.

本文从抓住一个中心、孕育两种文化、建设三组体系、树立四项标准四个方面,论述在军改与医改的时代背景下,军队中心医院科学管理与建设发展的策略以及应关注的重点环节,为军队医院管理者加强医院科学管理,促进医院可持续发展提供借鉴.

目的 通过对个体需求层次的满足干预,调查某军队医院合同制医师在需求层次满足前后心理健康状况的变化.方法 采用症状自评量表(SCL-90)对某军队医院120名合同制医师进行问卷调查.结果 干预前总均分和躯体化、强迫、人际关系、抑郁、焦虑、敌对、精神病性7项因子分显著高于国内常模(P＜0.05),其他因子分与国内常模无显著性差异(P＞0.05);干预后总均分及躯体化、强迫、人际关系、抑郁、焦虑、敌对、精神病性7项因子分显著低于干预前(P＜0.05),但干预后总均分和强迫、抑郁、焦虑3项因子分仍高于国内常模(P＜0.05).结论 某军队医院合同制医师心理健康状况低于国内常模,需求层次的满足干预对心理健康状况的改善有一定影响.

In this paper,five patterns of partner assistance to urban and rural health work,such as conglomerate medical pattern,specialist clinic center pattern,designated hospital guidance pattern,closely team managed pattern and clinical rounds across hospital pattern were introduced.Based on the practice in our hospital,this paper introduced the basic meaning specifically,main methods and implementation effect of those five patterns.And in this paper,several viewpoints were proposed.The administrative departments of public health should make a master plan for partner assistance work in two dimensions of vertical and horizontal.Both sides of partner assistance work should adhere to the principle of mutual benefit on academic evaluation and dual referral.Partner assistance work was not only a challenge,but also a chance in many aspects,such as enhancing driving force,integrating advantageous resources,improving grading diagnosis and treatment,and perfecting health information network,etc.

Based on the foundation and guidance of precise management,it accounts for the primary connotation and practical significance of innovation of management thoughts,precision of management procedure,specification of management parameters,wide-acquaintance of management process and humanization of management measures performed in the public hospital,and introduces how to execute precision management and how to explore a regular structure and operational management mechanism by means of information technology.

Operation quality and safety closely connected with patient's health and life.By using informationization platform,establishing a management system,development of surgical grade directory,specifying surgeon permissions rules,implementation of the grading surgical management,the medical safety was ensured.

<正>利用社会资源开展医疗合作项目在目前军队医院中已不是新鲜事物,绝大部分合作项目在促进医院和专科建设与发展方面起到了积极的推动作用。但是,由于所有的合作项目均存在着追求利益最大化的商业性特征,大多数在医疗服务上考虑较多,一定程度上影响了医疗质量。我院发现此类问题后,对

以解放军第251医院为例,说明门诊分诊导医信息管理系统的功能应用.该系统由硬件与软件组成,硬件主要有LED、LCD、PDP,软件主要有服务器、分诊、客户程序;分诊程序包括:门诊挂号大厅信息显示,医院综合信息发布,导诊,检验、检查、图像结果报告提示,分诊叫号系统等.系统功能主要是自动分诊、导医、叫号、语音对讲、信息同步跟踪刷新显示、挂号、收费、候诊信息查询、医院综合信息发布、患者自动换号、病人自主择医、优先选择、医生终端数据自动采集、动态信息交换、数据查询等,同时与住院医、护工作站对接,门诊与住院病人的信息实现时共享.应用该系统,基本实现利用信息手段节约人力成本、方便患者就医、提高工作效率、优化服务流程的目的,有效提升了管理效能.

近年来工伤意外、交通事故、恐怖活动及其他突发事件有明显上升的趋势,多发伤、危重伤大幅度增加,对急救输血提出更高的要求,及时、快捷、充足、准确、优质的血液供应是挽救生命的根本保证.军队医院日常工作程序不适应急救输血的要求,有必要建立平战一体急救用血的管理规范.

The article introduced the contents,function and application of subsidiary decision support system for hospital rational medication diagnosing and treatment.The system was composed of information inquiry center,instantaneity auxiliary decision-making hints,patient attribution recognition,control section online supervising and managing medicine to guarantee,the new rural corporative medical insurance,the rational application of serviceman diagnoses and treatment,meditation monitoring data analysis,the data maintenance,constitutions and so on.The functions included information inquiry,the patient attribute recognition,the instantaneity assistance decision-making prompt,the patient pre-settlement expense share,online supervision and management,data statistical analysis,which enhanced the level of rational medication and diagnose,promoted the comprehensive competitive of hospital.

The necessity of Electronic Medical Record Public (EMRP) were described in this article.EMRP requires perfectly organizing,publicizing and educating.EMRP should be preceded step by step after EMR unified systemically and with the authority to print it.EMRP could make the relationship between patients and doctors harmony,reduce the medical disputes,increase strength of the competition,and realize quick and continual development of hospital.

<正>我院从2003年开始进行ISO9000体系认证,通过实施PDCA(计划、实施,证据,改进)的持续改进过程,写你所做的,做你所写的,记你做过的,查你所做的,改你做错的。强调符合性、适宜性、有效性,每项工作、每个环节都有规范统一的标准和流程,

Objecgive:To discuss the diagnosis and surgical treatment of the pulmonary inflammatory pseudotumor.Methods:Analysis of the examination and operations of 48 cases suffered from pulmonary inflammatory pseudotumor.Results:No postoperative complication,all patients were cured.Conclusion:The operation is a effective method for the treatment of pulmonary inflammatory pseudotumor.

目的 将医院各类物资纳入网络化管理,实现资源共享.方法 将医院各类物资入库到一级库,对固定资产和高值耗材实行条形码管理,结果与结论这种管理办法为医院实行全成本核算提供了准确数据,同时提高了工作效率,值得推广.

树立医院品牌效应和提升医院文化建设与医院管理体制和医院管理模式有着极为深厚的联系,特别是在当今时代,和谐医院的构建更应该充分运用文化建设和品牌效应等有效手段调和医患关系,在原本认为存在根本利益冲突的医患关系之中寻求平衡点和支撑空间,弥补传统就医模式或管理体制下医患关系处理方式的不足,本文试从文化建设与品牌效应这一独特领域来研究如何构建和谐医患关系。

Objective:To bring the accounting of military patients into hospital performance management to improve the medical servie quality for the army.Methods:To formulat the army basic drug and inspection directory,to establish the system of virtual income actual medical expenses of military patients to implement total cost accounting to military patients.Results and Conclusions:The practice improved the social benefit,economic benefit and military benefit.