如何降低ICU费用——规范ICU的建设和管理

ICU收费高的主要症结在于ICU的建设和管理需要规范化,包括在中国制定ICU的收治和转出指征规范,减少过度医疗和延迟医疗;积极配备ICU人力资源,提高监护质量,培训ICU专业医师上岗,掌握并运用专业知识施救,保证治疗的恰当性。允许恰当的家属陪护,对患者给予情感支持,或可降低镇静药物等的使用,缩短住院日;对于脑死亡、植物状态以及癌症晚期或其他晚期疾病的临终患者,提倡放弃治疗,避免无益救治造成卫生资源的浪费,对家属造成巨大的精神压力和经济负担。但是医生主动放弃治疗的决定尚需要政策的支持和法律的保障。     

53例ICU死亡病人医疗费用的伦理讨论与控制对策

５３例ＩＣＵ死亡病人医疗费用的伦理讨论与控制对策北京医科大学（１０００８３）李本富冷强本文通过５３例外科ＩＣＵ死亡病人的医疗费用回顾性总结和统计分析,在此基础上进行伦理讨论,并提出控制对策,以供政府有关部门、医疗单位和医务人员参考。一、调查材料与方法...     

冠心病介入治疗过度应用的分析和对策

介入治疗是冠心病治疗的重要进展和手段之一,可以改善急性心肌梗死患者的生存率。但目前也出现了过度使用的问题。冠心病本身的特点、医生对冠心病治疗认识不全面和现行医疗制度的不合理部分是其产生原因;建立正确的冠心病诊治策略,深入改革医疗体制,加强医师职业道德培养,同时注意辩证分析过度医疗才能科学合理的应用介入治疗造福冠心病患者。     

个性化指南：提高质量和降低费用的潜力

在2011年5月3日的美国内科年鉴上大卫博士指出,目前的治疗指南集中于一个特定的风险因素,针对已经分类的少量的治疗患者制定村关的治疗标准。而大卫博士的研究在当前血压的管理方面,赋予患者个性化的指导方针,即用来自每个人的呵利用的个性特征．降低疾病风险,     

外科医生的决策与医疗费用和人力资源

在美国有这样一个例子,一名整形外科医生和麻醉师之间进行的交流。外科医生想要了解手术室里的情况：”有一个骨折,我需要解决它。”麻醉师为他提供更多细节,但外科医生简单地重复先前的话：”有一个骨折,我需要修复它。”     

四川中江县白塔寺:努力建设爱国爱教管理规范的智慧寺院北大核心

四川省德阳市中江县的白塔寺,前临凯江,蜿蜒绵长的凯江水滔滔不绝地绕寺奔腾;背靠北塔山,巍峨山顶上的宋代古塔直插云霄。映在绿树丛中的寺院,杏黄色的院墙,青灰色的殿脊,建筑错落有致,寺内祥和宁静、肃穆庄严。作为县佛教协会的驻地,白塔寺始终高举爱国爱教旗帜,坚守“政治红线、安全底线”,坚持宗教中国化、管理规范化,大胆创新,努力建设爱国爱教、管理精细、建筑精致、环境优雅的“智慧寺院”。     

ICU护士角色模糊-角色冲突和工作疲溃感对其组织承诺的影响

了解ICU护士的角色模糊-角色冲突、工作疲渍感和组织承诺水平,探讨角色模糊-角色冲突和工作疲溃感对ICU护士组织承诺的影响作用.角色模糊对ICU护士的组织承诺有显著的预测作用(P＜0.01).在情感承诺方面,角色模糊和情绪疲溃感有显著的负向预测作用(P＜0.01);情绪疲溃感和个人工作无成就感对继续承诺有显著的影响(P＜0.05);情绪疲溃感、角色冲突和角色模糊对规范承诺有显著的负向预测作用(P＜0.05).护理管理者应采取积极有效的措施减轻其影响,稳定护理队伍,提高护理质量.     

住院和门诊患者对医疗差错诉求支付的费用

Bishop博士指出支付的医疗事故索赔的分析可能会提供对门诊的医疗差错的发生率和严重性的洞悉作用。本研究目的报告和比较了医疗事故索赔支付住院和门诊设置的事件。回顾性分析医疗事故索赔支付代表在门诊医生和住院医生的设置中,使用从2005年到2009年的全国从业者资料库数据。     

对"医疗服务商品和市场"存在客观性和必然性的理性思考--兼评《对中国医疗卫生体制改革的评价与建议》

针对国务院发展研究中心课题组发表的<对中国医疗卫生体制改革的评价与建议>提出的卫生改革带来"问题的根源在于商业化、市场化的走向违背了医疗卫生事业发展的基本规律."提出"医疗服务商品"、"医疗服务市场"的存在是客观的,并通过反驳<评价与建议>提出的四对矛盾,提出"医疗服务商品"、"医疗服务市场"的存在也是必然的,最后分析了所谓"卫生改革失败"的真正原因.     

在主日礼拜的事奉--教会如何管理主日礼拜

一、手洁心清话卫生有的堂点在分发圣餐时,传道人刚讲完道,合上圣经,手也未洗,便去掰饼。这显然是不卫生的,尤其在某些疾病流行时期,很容易使得一些体质较弱的弟兄姊妹感染上病菌,造成疾病。笔者建议圣餐的主礼者除“心清”外,还必须“手洁”,要在掰饼前认真地洗手。有传染病者或健康带菌者(如乙肝)最好不参加掰饼。     

如何减少医疗差错

医疗差错是危及医疗安全、制约医疗质量、影响医患关系、引发医患纠纷的核心问题,是医院管理的重点和难点.本文通过对医疗差错的分析和美国七大减少医疗差错的借鉴来探讨如何结合我国医院的实际来有效地减少医疗差错的发生.     

如何减少医疗差错

医疗差错是危及医疗安全、制约医疗质量、影响医患关系、引发医患纠纷的核心问题,是医院管理的重点和难点。本文通过对医疗差错的分析和美国七大减少医疗差错的借鉴来探讨如何结合我国医院的实际来有效地减少医疗差错的发生。     

How Individuals and Organizations Can Reduce Interpersonal Discrimination

Individuals do not always face overt, unambiguous forms of discrimination that often have legal repercussions. Rather, the current paper introduces the construct of interpersonal discrimination, a set of behaviors (e.g., increased interpersonal hostility, decreased eye contact, abbreviated interactions) that has negative implications for both individuals and organizations. For individuals, interpersonal discrimination may result in consequences such as lowered performance (2009, doctoral dissertation, Rice University). For organizations, this type of discrimination may lead to negative bottom line consequences (Journal of Applied Psychology, 91 , 2006, 579–592). Individuals and organizations can both take steps to combat this discrimination and in this article, we review these strategies. While research on some individual‐level strategies in reducing interpersonal discrimination is showing success, the research on other strategies (from allies and organizations) is sparse, and we end by encouraging such future research.     

Flexibility competencies: emotional organization management

The aim of this article is to analyse the transferral of flexibility from contemporary organizations to workers. Through the approach of management by competencies, organizations try to develop in their workers behaviours that are related to efficient job performance. In order to appraise the importance of this approach, we used a critical-rational perspective to discuss the productivity demands that are characteristic of advanced industrial societies. The article shows how the link between workers' flexibility management and their emotional competencies affects their lives, which, like the organizations, should be versatile and adaptable to change.     

How goals affect the organization and use of domain knowledge

Expert specialists organize their knowledge around information related to their goals. In the experiments presented here, the relation between goal use and knowledge organization was investigated by manipulating participants' goals as they learned about a novel domain. Experiment 1 showed that goal use produces biases toward goal-related information in categorization and induction. Experiment 2 revealed that the bias toward goal relatedness is not absolute; participants use their knowledge flexibly, depending on the context of induction. Experiment 3 showed that using information in the absence of a meaningful goal does not produce significant goal-related biases. Altogether, the effects of goal use are evident across a number of tasks and may depend on goal meaningfulness and the coherence it provides to goal-related knowledge structures.     

How to Talk about Gender Inequity in the Workplace: Using WAGES as an Experiential Learning Tool to Reduce Reactance and Promote Self-Efficacy

Interventions aimed at raising awareness of gender inequity in the workplace provide information about sexism, which can elicit reactance or fail to promote self-efficacy. We examined the effectiveness of experiential learning using the Workshop Activity for Gender Equity Simulation ?C Academic version (WAGES-Academic) to deliver gender inequity information. To assess whether the way gender inequity information is presented matters, we compared WAGES-Academic to an Information Only condition (knowledge without experiential learning) and a Group Activity control condition. We predicted that only the information presented in an experiential learning format (i.e., WAGES-Academic) would be retained because this information does not provoke reactance and instills self-efficacy. Participants (n?=?241; U.S. college students from a large mid-Atlantic state university) filled out a gender equity knowledge test at baseline, after the intervention, and then 7?C11?days later (to assess knowledge retention). In addition, we measured feelings of reactance and self-efficacy after the intervention. Results revealed that participants in the WAGES condition retained more knowledge than the other conditions. Furthermore, the effect of WAGES vs. Information Only on knowledge was mediated by WAGES producing less reactance and greater feelings of self-efficacy. Results suggest that experiential learning is a powerful intervention to deliver knowledge about gender equity in a non-threatening, lasting way.     

On the experience of self-relevant feedback: How self-concept organization influences affective responses and self-evaluations

We evaluated how self-concepts are represented in memory, testing predictions about how self-relevant feedback influences mood and self-evaluation. Specifically, we view the self as comprised of multiple self-aspects (e.g., daughter, sorority sister), each associated with specific attributes (e.g., shy, philanthropy). Study 1 showed that priming a self-aspect increased the accessibility of attributes idiosyncratically associated with the activated self-aspect. In Studies 2 and 3, positive or negative self-relevant feedback was provided to observe how affect and self-evaluations are mediated by self-concept representation. Study 2 demonstrated that changes in mood were accounted for by how feedback impacted evaluations of the currently activated self-aspect. Moreover, evaluations of other self-aspects shifted as they shared more attributes with the self-aspect implicated by feedback. In Study 3, feedback about an attribute also influenced affect, with stronger mood change revealed for attributes associated with a greater proportion of self-aspects. This work demonstrates that affective experiences resulting from self-relevant feedback are not determined by one’s self-concept representation in its entirety, but rather, by the impact of that feedback on activated self-aspects.     

哮喘控制稳定后如何减停糖皮质激素

糖皮质激素是最有效的抗气道炎症药物,吸入糖皮质激素(ICS)是首选哮喘控制药物。由于治疗后达到哮喘临床控制(症状、肺功能)需要一定时间,ICS达到一定剂量后量效曲线较平坦,而全身不良反应却逐渐增加。因此,达到临床控制后在长期监测下至少维持哮喘控制3个月以上,开始减少50%ICS剂量,直至ICS减至最低维持剂量。如为ICS加另一种控制药(长效β2受体激动剂、白三烯调节剂、缓释茶碱)联合治疗达到控制者,在ICS减至最低剂量时再停用另一种控制药。应用最低剂量ICS维持控制达1年方可考虑停药。     

哮喘控制稳定后如何减停糖皮质激素

糖皮质激素是最有效的抗气道炎症药物,吸入糖皮质激素(ICS)是首选哮喘控制药物.由于治疗后达到哮喘临床控制(症状、肺功能)需要一定时间,ICS达到一定剂量后量效曲线较平坦,而全身不良反应却逐渐增加.因此,达到临床控制后在长期监测下至少维持哮喘控制3个月以上,开始减少50%ICS剂量,直至ICS减至最低维持剂量.如为ICS加另一种控制药(长效β2受体激动剂、白三烯调节剂、缓释茶碱)联合治疗达到控制者,在ICS减至最低剂量时再停用另一种控制药.应用最低剂量ICS维持控制达1年方可考虑停药.