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The Optimization and Control of Process in the Peak Flow of Physical Examination

【摘要】　目的　探讨如何通过流程优化应对体检高峰期。　方法　通过体检高峰期流程优化前后（2008年与2010年）的管理成效对比，评估高峰期流程控制的有效性。　结果　体检高峰期流程优化后，平均候检人数由8人下降至3人、平均侯检时间由11.9 min下降至4.2 min，平均体检时间由175 min下降至130 min。体检者对体检环境、服务态度和服务质量的满意度均高于优化前，差异有统计学意义（Plt;0.05）。　结论　通过流程优化与控制有效地缓解了高峰期体检人员等候时间过长现象，极大地提高了体检者满意度，保障了健康体检工作质量。【Abstract】　Objective　To explore how to cope with the peak flow of physical examination through the process optimization.　Methods　Evaluate the utility of the process control at physical examination peak flow, by contrasting the management effect before and after the physical examination peak flow optimization (2008 and 2010).　Results　After the process optimization in peak flow, the average number of people waiting to be checked is down to 3 from 8, the consumers′ satisfaction with the medical environment, service attitude and the service quality is higher than before optimization, the difference was significant (Plt;0.05).　Conclusion　Through the process optimization and control effectively relieve the time for waiting to be examined, greatly enhance the satisfaction of people who take physical examinations and ensure the quality of physical examination.

The Research on Factual Clearing Method for Group Physical Examination with the Management of Six Sigma

目的　探讨团体体检据实结算的方法，提高体检中心接检人员的工作效率和质量。 方法　采用六西格玛法, 并通过其定义、测量、分析、改进、控制5个步骤，研究并改进团体据实结算的方法，同时对比分析方法改进前后，“清理分检未完”的单次工作量、单次制表时间、单次核实时间以及缺陷发生率。 结果　方法改进后，“清理分检未完”的单次工作量变化无统计学意义（P＞0.05）；单次制表时间由（4.23 ± 0.43）h缩短至（0.06 ± 0.01）h、单次核实时间由（3.18 ± 0.46） h缩短至（1.07 ± 0.01）h、缺陷率从4.83%降至0.69%（P＜0.01）,达到了预期目标。 结论　运用六西格玛法可以发现流程中存在的关键问题,从而提出有针对性的改进措施,提高工作效率和质量。

四川省干部人群幽门螺杆菌感染现状及健康指导需求调查

目的 了解四川省干部人群幽门螺杆菌（Helicobacler pylori，Hp）感染现状、对 Hp 感染的认知程度及健康指导需求，为 Hp 感染的防治提供参考。 方法 对 2009 年 1 月—2014 年 12 月在四川大学华西医院健康管理中心进行体检的四川省干部人群进行碳 14尿素呼气试验检测，并对检测结果进行分析。随机抽取部分人群进行对Hp感染认知程度及健康指导需求的问卷调查。 结果 共纳入受检者 285 例，受检人群的 Hp 总感染率为 43.5%。收集合格问卷 128 份，对什么是 Hp、Hp 感染的危害、Hp 的传播途径、Hp 感染的预防措施、体检筛查 Hp 的意义 5 个问题的了解率分别为 21.1%、18.8%、16.4%、15.6%、12.5%；有上述 5 个方面健康指导需求的人数占比分别为 84.4%、85.2%、78.9%、86.7%、76.6%。 结论 四川省干部人群 Hp 感染率低于全国平均水平，但对 Hp 感染的认知程度低，迫切需要规范的健康指导。

尿道下裂术后伤口敷料包扎新方法的效果观察与护理

目的 探讨尿道下裂矫治术后伤口敷料包扎新方法的临床效果。 方法 将 2015 年 9 月—2016 年 3 月 80 例拟行尿道下裂矫治术的患儿按入院床位的单双号分为对照组和研究组，每组各 40 例。术后对照组采用传统的尿道下裂手术敷料包扎方式将阴茎直立包扎，研究组采用新的包扎方式让阴茎贴近下腹壁包扎。观察比较两组患儿每次伤口换药耗费的时间和出血量、伤口感染发生率和患儿家属的焦虑评分。 结果 研究组与对照组每次换药时耗费的时间分别为（21.80±2.54）、（21.45±2.65）min，差异无统计学意义（t=0.614，P=0.541）。研究组与对照组每次换药时伤口出血量分别为（0.74±0.62）、（0.82±0.87）mL，差异亦无统计学意义（t=–0.517，P=0.607）。研究组伤口感染 3 例，伤口感染率为 7.5%；对照组伤口感染 2 例，伤口感染率为 5.0%，两组比较差异无统计学意义（χ2=0.213，P=0.644）。研究组与对照组患儿家属的焦虑评分分别为（1.90±0.11）、（2.50±0.12）分，差异有统计学意义（t=–4.088，P<0.001）。 结论 尿道下裂敷料包扎的新方法可提升患儿的舒适度，敷料不易松脱，尿管不易打折，护理更方便，减轻了患儿家属的焦虑，值得推广。

Immune checkpoint inhibitors-related neuromyopathy

In recent years, immune checkpoint inhibitors have begun to be used in targeted cancer therapy. Despite the favorable results in terms of oncological outcomes, these treatments have been associated with a variety of immune-related adverse events. Neuromuscular disease is more common among adverse events involving the nervous system. With the increasing use of immune checkpoint inhibitors, the early recognition and treatment of neuromuscular immune-related adverse events are very important. In this review, we are focused on the epidemiology, pathogenesis, clinical manifestations, evaluation, diagnosis, and treatment of neuromuscular diseases (including peripheral neuropathy, myasthenia gravis, and myositis) caused by immune checkpoint inhibitors, aiming to provide a theoretical basis for improving the diagnosis and treatment ability of users of immune checkpoint inhibitors for such neuromuscular diseases and reducing the disability rate and mortality rate caused by immune checkpoint inhibitors.

先天性动眼神经麻痹伴上睑运动反常现象一例

Effects of Disease Classification Early Warning System on Operation Quality of Health Examination Center

Objective　Based on the PSQ-18 scale, to evaluate the effects of disease classification early warning system (DCEWS) on operation quality of health examination center (HEC). Methods　By means of the comparable and retrospective cohort study methods, using “PSQ-18” of American Rand Corporation as a tool, taking the date when HEC implemented DCEWS as node, and adopting statistic software for random sampling, it was divided into two groups: the traditional group (before implementing DCEWS, n=475) and the early warning group (after implementing DCEWS, n=473). The PSQ-18 scale scores of both groups were analyzed so as to assess the effects of DCEWS on HEC. Results　Such factors as sex, age, education level and family average monthly income had certain effects on the score of PSQ-18, but there was no significant difference between the two groups (Pgt;0.05); in the following 4 dimensions as the ways of interpersonal communication, degree of doctor-patient communication, convenience degree and the overall satisfaction of patients, the PSQ-18 scores of the traditional group and the early warning group were 4.0±0.92/4.2±0.97, 3.8±0.94/4.0±0.96, 4.4±0.60/4.6±0.6, 4.2±0.87/4.4±0.94, respectively, with significant differences (all Plt;0.05). Conclusion　The implementation of “Disease classification early waning system” can significantly increase the “patient satisfaction” of health examinees, and can significantly improve the operation quality of health examination center.

弱视儿童不同遮盖方式生活质量评定分析

目的 比较弱视儿童行眼罩遮盖和 Bangeter 压抑膜遮盖的生活质量评分。 方法 选择 2014 年 11 月—2015 年 9 月视光门诊 7～12 岁弱视儿童 98 例，自愿选用眼罩或 Bangeter 压抑膜遵医嘱进行遮盖，6 个月后复诊时采用弱视儿童生活质量评估量表进行评分对比。 结果 眼罩遮盖组和Bangeter 压抑膜组男童的生活质量评分的平均得分[（6.00±3.34）、（8.79±4.48）分]均低于女童[（7.30±3.46）、（10.11±4.46）分]，差异均有统计学意义（t=2.032、2.654；P<0.05）。Bangeter 压抑膜组男、女童的视力状况、心理状况、社会交往、疾病担心得分亦明显高于眼罩遮盖组，差异均有统计学意义（P<0.05）。 结论 运用 Bangeter 压抑膜遮盖可提高弱视儿童的生活质量。

The application of delicacy management in branch health management sub-center

Objective To evaluate the effects of delicacy management applied in branch health management sub-center. Methods From July 2013 to December 2015, integrated delicacy management was applied throughout the whole process of the preparation for the establishment and the running of the branch health management sub-center. The strengths and weaknesses of the management, the management of the details and the control of the emphasis were analyzed. And the medical visits and incomes after the application of delicacy management were also analyzed. Results From July 2013 to December 2015, the monthly average medical visits were 1 870.17±609.93, 2 842.50±1 247.60 and 3 717.92±1 257.98, while the monthly average incomes were (2 136.0±585.1) thousand yuan, (3 620.5±1 559.9) thousand yuan and (4 921.1±1 837.2) thousand yuan, which increased significantly. Conclusion The application of delicacy management in the branch health management sub-center could ensure the quality of service, promote the steady growth of performance, and improve the understanding of the surrounding population of health management, thus we can improve the economic and social benefits of the health management sub-center.

Improvement of the Use Value of Medical Equipment in the Health Management Center Based on PDCA Cycle

ObjectiveTo strengthen the management of medical equipment and improve the use value of medical equipment by PDCA cycle. MethodsBetween March and June 2014, we introduced PDCA cycle into the management and use of newly-bought equipment.The use of newly-bought arteriosclerosis detector, TCD and ultrasound bone densitometer between March and June 2014 was regarded as the control group (before the implementation of PDCA cycle), and the use of these three kinds of equipment between March and June of 2015(after the implementation of PDCA cycle) was seen as the observation group.By analyzing the status quo through collected information, we drew a fishbone diagram to find out the factors that could influence the use efficiency of medical equipment.Then, corresponding measures were taken for continuous improvement, including adopting revised regulations, training technicians, quantifying work indexes, informatization, changing service mode, and examining and assessing the effect of implementation.Finally, feedback was summarized for the next PDCA cycle. ResultsAfter the implementation of PDCA cycle, the daily check numbers of hospital medical equipment including arteriosclerosis detector, TCD, and ultrasound bone densitometer all improved significantly (P < 0.05).The daily check numbers of those three kinds of equipment after the implementation of PDCA cycle were respectively 48.52±19.72, 32.14±10.14 and 55.59±25.12, while the numbers before were respectively 32.46±20.69, 15.46±10.05 and 29.83±20.20.Moreover, working days, maximum working hours daily, and total working time were also increased after the implementation of PDCA cycle. ConclusionThe application of PDCA cycle can effectively improve the use value of medical equipment, and improve the social benefit and economic benefit.