乳腺癌治疗的新视野与医院管理的改革

阐述了乳腺癌治疗方法的发展过程,包括外科、内科、放疗科、生物治疗。乳腺外科由扩大根治手术发展到保乳手术,由局部的病变认识到全身病变。内科治疗与外科配合,与内分泌的治疗相结合,又有大量的新药出现,使内科治疗从姑息性治疗走向根治性治疗。加上放疗技术和放疗设备的进步,靶向治疗药的层出不穷使人们越来越认识到乳腺癌是需要综合性治疗,从而推论到对医院管理制度及方法的探讨。认为医院需要建立正确的核心价值观即与患者携手同行让生命不再灰色,表现出更多的人文关怀,利用高科技为患者提供个性化的综合治疗,并付以相应的管理制度。     

外科患者安全、医疗缺陷和并发症

在医疗工作中,由于客观存在的各种医疗缺陷、过失,甚至错误,会引起各种并发症,影响着患者安全。在以往常注意到了医疗工作中所发生的各种并发症的结果,但是没有或较少重视发生这些并发症的过程,以及在此过程存在的缺陷。在外科领域中,应注意可能发生外科并发症的环节和过程,尽量避免医疗缺陷,同时还要注意开展新技术,减少因技术能力不足带来的伤害;减少侵害性医疗干预。     

浅谈医院服务中的人性化

随着社会的发展,医院迫切需要实行人性化服务。诠释了人性化服务的内涵,探讨了服务意识淡漠的根源,提出了医院人性化服务的必要性和紧迫性,重点阐明了转变观念,树立“病人至上”的服务理念,以病人需求为导向,提高医院服务质量的人性化服务做法,并且提出了建立人性化服务的考核标准。     

医疗服务满意度调查中存在的问题分析

近几年以来,我国卫生领域对医疗服务满意度调查越来越重视,病人满意度调查已经在医院普遍应用。然而,医疗服务满意度调查中仍然存在着诸多的问题,主要是在调查的组织设计、调查的主体、问卷的设计、调查的方法等方面存在较大的缺陷,应该引起相关方面的重视,改进医疗服务满意度调查工作,加强医疗服务的薄弱环节。     

“无红包医院”的经济学解读与思考

对南通市第三人民医院打造“无红包医院”的实践进行了经济学解读,认为该院从“成本-收益”角度入手约束员工行为,确保“无红包医院”名副其实,是一种合理的制度安排;实践“无红包”承诺,既增进社会福利又促进医院自身发展,是一个互利共赢的成功范例;通过打造“无红包医院”品牌消除非对称信息,赢得长期稳固的竞争优势,是一项富有远见的战略选择。     

Swimming against the tide: the changing functions and status of chaplains in the Israel Defense Force

This article describes and analyses the changes that have occurred in the services performed by chaplains in the Israel Defense Force (IDF) – the only military in the world that consists almost entirely of Jews. Essentially, we argue, the shift has been one of focus. For many years, IDF chaplains primarily (albeit never exclusively) concerned themselves with providing religious services to the minority of personnel who observed Orthodox Jewish rituals. ‘Outreach’ programmes, targeted at the secular Jewish majority, were secondary. Recently, however, the IDF rabbinate has undergone a process of ‘role expansion’, emphasising the provision of counselling and guidance to the entire Jewish complement, especially in combat units. In the second part of the article, we analyse the possible reasons for that development: demographic and cultural trends in Israeli society; the prominence of counter-insurgency missions in the IDF’s operational agenda; and the personalities of recent chief chaplains. Finally, we address the possible implications of this shift, asking whether the intra-organisational frictions that it generates, especially with the Education Corps, portends a battle for the soul of the IDF.     

优抚医院疗养对象的社会支持与幸福感的关系:心理健康的中介作用

考察优抚医院疗养对象的幸福感现状,探讨其心理健康、社会支持与幸福感的关系。采用老年人心理健康问卷、社会支持评定量表、纽芬兰纪念大学幸福度量表对103名平均年龄82.43岁的优抚医院疗养对象进行调查。结果表明:(1)优抚医院疗养对象的幸福感与全国常模无显著差异,心理健康水平与社会支持状况都显著低于对照组;(2)优抚医院疗养对象的社会支持、心理健康水平和幸福感各维度之间存在显著正相关;(3)心理健康在社会支持对幸福感的影响中起中介作用;心理健康的情绪体验维度在客观支持对幸福感的影响中起部分中介作用。     

Real-world inpatient programs: Shedding some light-A critique

This critique is a response to an article by Morisse, Batra, Hess, Silverman, and Corrigan (1996), in which “a token economy for the real world” is promulgated as an alternative to the comprehensive social-learning program and assessment technology presented by Paul and Lentz (1977). The article misrepresents the treatment-and-assessment procedures that have been empirically validated as the most effective and cost-efficient for inpatient programs. The article also inappropriately cites the results of prior reports as support for an oversimplified approach to the development and implementation of inpatient programs. The promoted approach is in direct opposition to the widely recognized need for empirically validated interventions and evaluations in mental health services. Not only are data lacking to support assertions of effectiveness for the resulting program but illustrative examples demonstrate technically unsound procedures as well as an ethically questionable emphasis on staff desires to the exclusion of patient needs. We attempt to correct Morisse et al.'s inaccuracies and misconceptions regarding the work of Paul and colleagues, note the major problems with their perfunctory approach, and provide recommendations for implementation and maintenance of empirically validated procedures for inpatients.     

Knowledge and Attitudes of Hospital Nurses in Italy Related to Near-Death Experiences

I distributed Nina Thornburg's Near-Death Phenomena Knowledge and Attitudes Questionnaire to 750 nurses in three Verona hospitals, and received 476 completed questionnaires. Questionnaire respondents had a modest knowledge of near-death experiences (NDEs). Nevertheless, respondents expressed a positive attitude towards NDEs in general, and towards patients who had had NDEs. Thirty-four percent of the nurses had personally encountered NDErs, and those nurses reported a higher level of knowledge than their colleagues who had not had that opportunity. Furthermore, in relation to the global sample, nurses who had encountered an NDEr showed attitudes that were more positive regarding both the NDE itself and the type of assistance they offered NDErs.     

Judgmental relativism as a validity threat to standardized psychiatric rating scales

Judgemental relativism is a threat to the replicability and validity of measures of client behavior from direct rating scales whenever raters are exposed to different levels of client functioning since the internal standards, or anchor points, used to judge dimensional continua may vary on the basis of prior experience. Traditional interrater reliability indexes fail to identify such effects. The influence of judgmental relativism on summated ratings from the Nurses Observational Scale for Inpatient Evaluation (NOSIE-30) for 1040 adult mentally ill clients was examined with clinical staff raters from 24 treatment units in which the Time-Sample Behavioral Checklist (TSBC) provided full-week objective measures of actual client functioning via hourly direct observational coding (DOC). Regression analyses found that the same level of objective performance received higher or lower ratings across treatment units dependent on the raters'exposure to client groups that differed in level of functioning. Analyses of rating errors found that clients with better levels of functioning relative to others within treatment units were rated even higher than performance warranted. The operation of halo and contrast effects is explored and guidelines are provided for determining when judgmental relativism may produce or nullify significant differences. DOC assessments should be used instead of retrospective ratings to support most decisions in residential settings. Specific recommendations for the application of rating scales and improving data quality are provided.This study was the basis of a master's thesis at the University of Houston by Betty E. Rich under the direction of Gordon L. Paul and Marco J. Mariotto. Richard M. Rozelle, to whom appreciation is expressed for helpful comments, served on the examination committee. This study was partially supported by grants to Gordon L. Paul from the National Institute of Mental Health, Public Health Service (MH-15353; MH-25464); the Illinois Department of Mental Health and Developmental Disabilities; the Joyce Foundation; the MacArthur Foundation; the Owsley Foundation; the Cullen Foundation; and the Center for Public Policy, University of Houston.