Design and Analysis of Hospital Admission Control for Operational Effectiveness

Variability in hospital occupancy negatively impacts the cost and quality of patient care delivery through increased emergency department (ED) congestion, emergency blockages and diversions, elective cancelations, backlogs in ancillary services, overstaffing, and understaffing. Controlling inpatient admissions can effectively reduce variability in hospital occupancy to mitigate these problems. Currently there are two major gateways for admission to a hospital: the ED and scheduled elective admission. Unfortunately, in highly utilized hospitals, excessive wait times make the scheduled gateway undesirable or infeasible for a subset of patients and doctors. As a result, this group often uses the ED gateway as a means to gain admission to the hospital. To better serve these patients and improve overall hospital functioning, we propose creating a third gateway: an expedited patient care queue. We first characterize an optimal admission threshold policy using controls on the scheduled and expedited gateways for a new Markov decision process model. We then present a practical policy based on insight from the analytical model that yields reduced emergency blockages, cancelations, and off‐unit census via simulation based on historical hospital data.     

The Effect of Integrated Scheduling and Capacity Policies on Clinical Efficiency

In outpatient healthcare clinics, capacity, patient flow, and scheduling are rarely managed in an integrated fashion, so a question of interest is whether clinic performance can be improved if the policies that guide these decisions are set jointly. Despite the potential importance of this issue, we find surprisingly few studies that look at how the allocation of capacity, paired with various appointment scheduling policies and different patient flow configurations, affects patient flow and clinical efficiency. In this paper, we develop an empirically based discrete‐event simulation to examine the interactions between patient appointment policies and capacity allocation policies (i.e., the number of available examination rooms) and how they jointly affect various performance measures, such as resource utilization and patient waiting time. Findings suggest that scheduling lower‐variance, shorter appointments earlier in the clinic (and, conversely, higher‐variance, longer appointments later) results in less overall patient waiting without reducing physician utilization or increasing clinic duration. Additionally, exam rooms exhibited classic bottleneck behavior: there was no effect on physician utilization by adding exam rooms beyond a certain threshold, but too few exam rooms were devastating to clinic throughput. Some significant interactions between these variables were observed, but were not influential to the level of managerial concern. Clinicians' intuition about managing capacity in healthcare settings may differ substantially from best policies.     

医患关系的变化与医院的可持续发展

医疗体制改革的深入和市场经济的发展使医患关系发生了巨大变化 ,医患关系变成了法律或合同关系、经营者与消费者关系 ,患者已从过去的求医变成了现在的选择医生。如何应对这些变化 ?作者认为 ,医务人员应通过转变观念、依法行医、给患者提供优质服务等来建立市场经济条件下的融洽、相互信赖与尊重的新型医患关系     

替罗非班对老年急性冠脉综合征患者行PCI术的疗效及安全性分析

目的探讨血小板膜糖蛋白（GP）Ⅱb／Ⅲa受体拮抗剂替罗非班（tirofiban）对老年急性冠脉综合征患者行经皮冠状动脉介入治疗的疗效及安全性。方法选择2007年3月至2007年1275入院并明确诊断为ACS的患者53例，行PCI术并联合应用替罗非班治疗，按照年龄≥65岁和〈65岁将其分为老年组25例和非老年组28例。观察两组患者应用替罗非班后乳酸脱氢酶、肌酸激酶同工酶、肌钙蛋白及凝血指标的改变与血小板减少症、住院期间出血事件的发生情况。结果PCI术后联合应用替罗非班均可减轻两组患者的心肌损伤程度，LDH、CK—MB、cTnI较术前均显著降低（P〈0．01）；住院期间老年组患者凝血指标的改变和出血事件的发生率有高于非老年组的趋势，但两组间的安全谱无显著性差异（P〉0．05）。结论PCI术后联合替罗非班治疗对老年急性冠脉综合征患者是安全有效的，并不明显增加出血并发症的发生。     

"He is anxious to teach"与"He is difficult to teach"之比较及其它

"He is anxious to teach"与"He is difficult to teach"中"he"的位置一致,但其论旨角色不同,"he"在前句中是施事,但在后句中是受事.乔姆斯基中的"标准理论"以及玻尔马特"非宾格动词假设"理论和"普遍联系假设"理论对此现象进行了阐释.其中玻尔马特之"非宾格动词假设"理论对此及其他相关现象更有解释力.     

A Decision Aid for midwifery continuity of care: Development and pilot acceptability testing

BackgroundMany maternity services in Australia offer women a variety of models of care including midwife led models. Childbearing women, however, need to understand the differences between these models if they are to make an informed decision about their choice of care. Decision Aids (DA) help people decide when there is not a single best option and the best decision will be based upon the values of the decision maker. There is no current tool that focuses on the choice of midwife led vs other models of maternity care.AimThis research aimed to develop, and pilot test a Decision Aid focusing on the choice between midwife led and standard models of maternity care.MethodsThe DA was developed using the International Patient Decision Aid Standards and pilot tested for acceptability with a group of clinicians who provide antenatal care in one jurisdiction in Australia. A posttest only study was conducted assessing knowledge, acceptability and decisional conflict, with a group of women of childbearing age living in the jurisdiction.FindingsA DA was developed and pilot acceptability testing with 14 women and 13 clinicians of Australian Capital Territory (ACT) health demonstrated its acceptability and highlighting areas for further development.DiscussionSome revisions may be needed to address issues of balance and bias toward midwife-led care identified by some recipients.ConclusionPilot acceptability testing with women and staff of ACT health provides a steppingstone to further research, development and evaluation of this DA.     

标准化病人在内科学教学中的应用效果

目的：观察标准化病人（Standardized Patient,SP）在内科学教学中应用的效果。方法：在社会上公开招聘一定数量的自愿者。经过三个月相关疾病的系统培训、考核后,有8名自愿者成为内科SP。用辽宁医学院在临床内科实习的大五学生26名,分别对相同疾病的真实病人和SP进行问诊与查体实习（学生不知谁是真实病人,谁是SP）,并请同学对真实病人和SP的演示能力及效果进行评估,以检验SP的应用效果;问诊、查体结束后,分别由带教老师和SP给学生进行评估,作为对学生问诊内容和查体内容是否全面及符合要求的评判。结果：SP在扮演病人的演示与真实病人问差异无显著性;学生在应用真实病人和SP进行临床实践所获得的成绩差异无显著性。结论：SP在内科学及其实践教学中具有其推广价值和意义。     

医院图书馆开展对患者服务工作的思考

针对目前医院图书馆服务对象多限于本院医务工作者的情况,分析了医院图书馆为患者及家属服务的必要性和可行性,探讨了医院图书馆通过有效的保障措施,为患者及家属提供优质服务的内容与途径,从而最大限度地体现医院图书馆的价值。     

‘Widening cross-disciplinary research for mental health’: what is missing from the Research Councils UK mental health agenda?

This current issues article is a brief critical examination of the recent Research Councils UK agenda and call for cross-disciplinary research in mental health. Our argument is based on the fact that patient and public involvement (PPI) is the only involvement and influencing strategy for service users and survivors in the agenda. Service user and survivor research as a discipline in itself remains unacknowledged. We conclude that service user and survivor research is distinct and is different to PPI, and should be recognised in any mental health research agenda.     

“受事＋施事＋vp”型主谓谓语句的句法、篇章功能考察

“受事＋施事＋vp”型主谓谓语句的形成和使用受到句法、篇章的制约。在句法上有强调、突出受事主语和强调、突出补语成分的作用。在篇章中,受事主语有衔接连贯、对比和开启下文的作用,衔接连贯的受事主语能够使文气顺畅;对比的受事主语带有话题焦点的性质;开启下文的受事主语可以使主题统一;施事主语有对比强调和开启下文的作用,对比强调的施事主语带有对比焦点的性质;开启下文的施事主语起到主题统一的作用。