本文分析了广州市南沙区某公立医院人力资源管理现状,并基于SWOT分析法探索其发展策略。研究发现,该医院的人力资源管理具有成熟的管理体系和一体化管理的实施优势,但也面临财政支持不足和人才及岗位结构不均衡的劣势。政策支持与区域医疗资源扩展为其提供了重要的机遇,但日益增长的行业竞争和人才吸引与保留的难题构成了威胁。医院应优化管理架构,加强顶层设计,改善学科和人才结构,采取一体化与差异化发展策略,以构建高效的人才队伍,提升医院竞争力。本文通过对优势、劣势、机遇和威胁的综合分析,制定了针对性的管理对策,为同类医疗机构提供了参考。

This paper analyzes the current state of human resource management（HRM）in a public hospital in Nansha District,Guangzhou,and explores development strategies based on a SWOT analysis．The study reveals that the hospital’s HRM benefits from a mature management system and the implementation of integrated management．However,it also faces challenges such as insufficient financial support and an imbalance in the structure of personnel and positions．Policy support and the expansion of regional medical resources present significant opportunities,while increasing industry competition and challenges in attracting and retaining talent pose threats．The hospital should optimize its management structure,enhance top-level design,improve the discipline and personnel structure,and adopt integrated and differentiated development strategies to build an efficient talent team and enhance its competitiveness．Through a comprehensive analysis of strengths,weaknesses,opportunities and threats,this paper formulates targeted management strategies,providing valuable references for similar medical institutions．

目的 分析广州某三甲医院脑梗死患者住院费用的变化以及影响因素,为有效减轻患者疾病经济负担提供参考依据。方法 提取广州某三甲医院2015—2022年出院诊断ICD-10前三位编码为I63的病案首页数据,并采用IBM SPSS 20.0软件对费用结构进行描述性统计分析,以多重线性回归分析患者住院费用的影响因素。结果 2015—2022年脑梗死患者的平均住院费用年均增长率为2.86%;费用结构以药品费为主,占比逐年下降,至2022年占比为27.74%,技术劳务性费用占比逐年增加,至2022年占比为47.41%;住院费用主要受医院感染情况、住院天数以及支付方式等因素影响（F=990.10,P<0.001）。结论 脑梗死患者的住院费用结构显著优化,但患者的疾病经济负担仍然较重,且费用受多种因素的综合影响。建议通过提高医疗质量与服务效能,并严格落实临床路径管理,减少不必要的检查以及耗材使用,以期最大程度地减轻患者的负担。

Objective To analyze the structural changes and influencing factors of the hospitalization expenses for patients with cerebral infarction in a tertiary general hospital in Guangzhou,and provide a scientific basis for reducing economic burden of the patients．Methods The front page data of medical records with the main diagnosis of I63 were collected in the sample hospital．Descriptive statistics analysis of hospitalization expenses structure and multiple linear regression analysis of the influencing factors were carried out by SPSS 20.0．Results The annual growth rate of average hospitalization expenses of cerebral infarction patients from 2015 to 2022 in the sample hospital was 2.86% per year．The highest proportion of hospitalization expenses was medicine fee,the proportion of which declined year by year with a minimum 27.74% in 2022．The proportion of technical labor costs accelerated year by year with a maximum 47.41% in 2022．This study revealed the main factors influencing hospitalization expenses were hospital internal infection or not,length of stay,payment method and so on（F=990.10,P<0.001）．Conclusions The structure of hospitalization expenses for cerebral infarction patients was significantly optimized,but the economic burden of patients was still heavy affected by a combination of factors．In order to minimize the burden of patients,hospitals should improve medical quality and service efficiency and implement clinical pathway management strictly,to reduce unnecessary inspections and consumables．

目的 对医疗损害责任纠纷案的法庭审理进行分析,探究医疗损害责任纠纷案件的处理现状,对此过程中医疗机构应当关注的问题进行分析总结,以期为医院应对医疗损害鉴定工作和法官审理医疗损害责任纠纷案提供参考。方法 对广州市三所综合医院2015—2021年共93例医疗损害责任纠纷案的判决书进行描述性分析。结果 93例案例中79例进行了医疗损害鉴定。79例进行医疗损害鉴定的案例中,71例鉴定结论被法院采信,采信率达90%。有29例案件鉴定人出庭（占比36.7%）,其中有25例鉴定意见被法院采信,采信率为86.2%,仅有7例案例当事人申请了专家辅助证人出庭。医方大多数最终承担次要及以下责任,占比为73.4%。鉴定结论为责任范围的,法院最后判决偏向于取最高值和中间值（43例出具责任范围的案例中,14例为最高值,13例为中间值）。结论 医疗机构要充分加强对医疗事故技术鉴定和医疗损害鉴定的认识,高度重视医疗损害鉴定工作,尤其加强尸体解剖告知及病历书写管理,充分利用好鉴定人和专家辅助证人出庭两种手段。

Objective To analyze the court trial of medical damage liability disputes,to explore the current situation of medical damage liability disputes,to analyze and summarize the problems encountered in dealing with medical damage disputes,so as to provide some references for hospitals to deal with medical damage disputes．Methods Descriptive statistical analysis performed on the written judgment of 93 cases of medical damage liability disputes in three large comprehensive hospitals in Yuexiu District,Guangzhou from 2015 to 2021．Results In 93 cases,79 cases had expertise of medical malpractice．In 79 expertise,71 of them were adopted,and the acceptance rate was 90%．Among the 29 cases in which the appraisers appeared in court,25 expert opinions were accepted by the court,the acceptance rate was 86.2%．In only 7 cases,the parties applied for expert witnesses to appear in court．In most cases,hospitals ultimately took secondary and lower responsibilities,accounting for 73.4%．If the appraisal conclusion falls within the scope of responsibility,the court's final judgment tends to take the highest and middle values．Conclusions Medical institutions should fully strengthen their understanding of technical identification of medical accidents and medical malpractice identification．Attach great importance to the identification of medical malpractice,especially strengthen the management of autopsy notification and medical record writing,make full use of two methods：appraisers and experts witnesses appearing in court．

目的 探讨便携式超声仪超声重点评估（e-FAST）技术在批量伤员军地联合院前救治中的应用效果。方法 抽取2021年5月—2023年10月中国人民解放军联勤保障部队第九八八医院中心急诊科收治的80例批量伤员,均开展军地联合院前救治,按照治疗方案不同分为观察组和对照组,每组患者40例,其中对照组在救治现场行基于创伤严重程度（CRAMS）评分,进行常规急救处置,救护车返院后行CT检查并进行相应伤情治疗,观察组救治现场行CRAMS评分,进行常规急救处置,院前接诊医师在现场或救护车上使用便携式超声仪按照e-FAST流程检查相应部位,初步诊断后进行相应伤情治疗,对比两组患者治疗效果,两组患者诊断时间、初次医疗接触—进入手术室时间及入院诊断与出院时确定性诊断的符合率、两组患者治疗前后CRAMS评分及CRAMS≤8分抢救成功率。结果 观察组治疗有效率为95.0%,对照组为85.0%,对比差异无统计学意义（χ²=2.222,P=0.136）;观察组患者的诊断时间（13.56±2.36）min、初次医疗接触—进入手术室时间（30.42±8.99）min均短于对照组[（23.64±5.69）、（52.27±12.60）min],差异有统计学意义（t=10.349、8.928,P<0.05）;观察组患者入院诊断与出院时确定性诊断的符合为97.5%,对照组患者入院诊断与出院时确定性诊断的符合为95.0%,差异无统计学意义（χ²=0.346,P=0.556）;治疗后两组患者的CRAMS评分均升高,且观察组（9.87±2.62）分高于对照组（8.60±2.98）分,差异有统计学意义（t=2.024,P=0.046）;观察组患者CRAMS≤8分的抢救成功率为97.50%,对照组CRAMS≤8抢救成功率为85.00%,观察组患者CRAMS≤8分的抢救成功率高于对照组（χ²=3.914,P=0.048）。结论 本研究从军地联合救治批量伤员切入,瞄准部队医院军民融合战略发展路线,本文针对便携式超声仪e-FAST应用范围前移,明显地提高急救人员院前救治能力,提高抢救成功率,值得临床参考。

Objective To explore the application effect of portable ultrasound e-FAST technology in the pre hospital treatment of batch wounded soldiers in military civilian joint hospitals．Methods Eighty batch wounded patients admitted to the emergency department of 988 Hospital from May 2021 to October 2023 were selected,all of whom underwent military civilian joint pre hospital treatment．They were divided into an observation group and a control group according to different treatment plans,with 40 patients in each group．The control group received CRAMS scores at the treatment site for routine first aid treatment,CT scans after ambulance return to the hospital for corresponding injury treatment,the observation group received CRAMS scores at the treatment site for routine first aid treatment,and the pre-hospital attending physician used a portable ultrasound instrument to examine the corresponding parts on site or in the ambulance according to the e-FAST process．After preliminary diagnosis,corresponding injury treatment was carried out．The treatment effects of the two groups of patients were compared,and the diagnosis time and initial diagnosis of the two groups of patients were compared．The time from medical contact to entering the operation room,the compliance rate of discharge and admission diagnoses,the CRAMS score before and after treatment,and the success rate of rescue with CRAMS ≤ 8 for both groups of patients were compared．Results The effective rate of treatment in the observation group was 95.0%,while in the control group it was 85.0%,which difference was not statistically significant（χ²=2.222,P=0.136）．The time to diagnosis（13.56±2.36）min,time to the operating room（30.42±8.99）min were shorter than that in the control group[（23.64±5.69）,（52.27±12.60）min],with significant difference（t=10.349,8.928,P<0.05）．The consistency between the admission diagnosis and the definitive diagnosis at discharge of the observation group patients was 97.5%,while the consistency of the control group patients was 95.0%．There was no significant difference between the groups（χ²=0.346,P=0.556）．After treatment,the CRAMS scores of both groups of patients increased,the observation group（9.87±2.62）was higher than that of the control group（8.60±2.98）（t=2.024,P=0.046）．The success rate of CRAMS ≤ 8 rescue in the observation group was 97.50%,while the success rate in the control group was 85.00%．The success rate of CRAMS ≤ 8 rescue in the observation group was higher than that in the control group（χ²=3.914,P=0.048）．Conclusions This study focuses on the joint treatment of batch wounded soldiers by military and civilian forces,aiming at the development path of military civilian integration strategy in military hospitals．The application scope of portable ultrasound e-FAST has been moved forward,which significantly improves the pre hospital treatment ability of emergency personnel and improves the success rate of rescue．It is worth clinical reference．

目的 评估医院-社区-家庭一体化康复护理模式对慢性创面患者生活质量及创面愈合的潜在影响。方法 选择2023年1月—2024年6月在广州市第一人民医院接受治疗的慢性创面患者80例作为研究对象,所有患者在住院期间均接受基于溃疡面积、深度及是否合并感染等因素的综合治疗,包括彻底清创、创缘处理、负压治疗、感染控制等治疗,并接受常规护理。出院前,通过随机数字表法将患者分为两组,每组40例。两组患者在住院期间均接受常规护理,出院后,对照组接受延续护理并定期复查。干预组40例患者在出院后接受医院-社区-家庭一体化康复护理模式。入组时及护理3个月后,使用生活质量调查表（SF-36）对患者生活质量和创面愈合率进行评估。结果 干预组创面愈合率为（32.61±4.26）%,高于对照组（11.48±1.04）%,差异具有统计学意义（t=19.473,P<0.05）。两组患者在护理3个月后的数字评定量表评分和创面疼痛频率评分均较入组时降低（P<0.05）。其中干预组护理3个月后的创面VAS评分为（1.82±0.17）分,创面疼痛频率评分为（1.28±0.25）分;而对照组分别为（3.91±0.22）分和（2.63±0.37）分,干预组低于对照组（P<0.05）。此外,干预组在护理后3个月的总体健康、生理功能、生理职能、精神健康、情感功能、社会功能评分均高于对照组（P<0.05）。在居家3个月期间,干预组的感染发生率为5.00%,而对照组为17.50%,干预组感染发生率低于对照组（χ²=3.781,P<0.05）。结论 本研究表明,医院-社区-家庭一体化康复护理模式干预能够促进慢性创面患者的创面愈合,降低居家期间感染的风险,并提升患者的生活质量。

Objective To assess the potential impact of the integrated hospital-community-home rehabilitation nursing model on the quality of life and wound healing in patients with chronic wounds．Methods A total of 80 patients with chronic wounds treated at the Guangzhou First People’s Hospital from January 2023 to June 2024 were selected as the study subjects．All patients received comprehensive treatment during their hospital stay,including thorough debridement,edge treatment,vacuum therapy,infection control and routine nursing care．Prior to discharge,the patients were randomly divided into two groups using a random number table,with 40 patients in each group．Both groups received routine nursing care during their hospital stay,and the control group received continuing nursing care and regular follow-up after discharge．Forty patients in the intervention group received the integrated hospital-community-home rehabilitation nursing model after discharge．Quality of life（QoL）and wound healing rates were assessed using the Short Form 36（SF-36）questionnaire at the time of enrollment and 3 months after nursing．Results The wound healing rate in the intervention group was significantly higher than that in the control group （[32.61±4.26]% vs [11.48±1.04]%）,with a statistical difference（t=19.473,P<0.05）．The numerical rating scale（NRS）scores and frequency of wound pain scores decreased in both groups 3 months after nursing compared to the enrollment period（P<0.05）．Specifically,the VAS score for wound pain in the intervention group 3 months after nursing was（1.82±0.17）,and the frequency of wound pain was（1.28±0.25）,in the control group,these scores were（3.91±0.22）and（2.63±0.37）,respectively,with the intervention group scoring significantly lower than the control group（P<0.05）．Furthermore,the scores for overall health,physical function,role physical,mental health,emotional function,and social function in the intervention group were higher than those in the control group 3 months after nursing（P<0.05）．During the 3-month home recovery period,the incidence of infection in the intervention group was 5.00%,whereas it was 17.50% in the control group,with the intervention group showing a lower incidence of infection（χ²=3.781,P<0.05）．Conclusions This study demonstrates that the hospital-community-home integrated rehabilitation care model intervention can promote wound healing in chronic wound patients,reduce the risk of infection during home care,and significantly improve patients’ quality of life．

目的 分析医院门诊西药房“分-全带教”模式的应用效果,为提高药房实习生的教学质量提供参考价值。方法 选取广州市番禺区中心医院药学部门诊西药房2020年9月—2022年7月的48例实习生（包含进修生、研究生）作为研究对象,对所有实习生实施“分阶段、分层级、分诊断单元窗口学习、全面能力培养”的“分-全带教”模式。观察所有实习生入科实习前后的考核成绩。结果 通过“分-全带教”实施后,实习生的理论知识（94.15±3.38）分、药学服务技能评分（90.56±3.99）分均比实习前有所提升,且实习生的学习兴趣（94.21±3.70）分、巩固知识点（91.98±3.56）分、提高医患沟通（92.73±3.81）分、认识自身技能不足（92.06±3.50）分同时提升（P<0.05）。结论 采用“分-全带教”模式明显提升对医院门诊西药房的实习生中的教学效果,实习生的理论和实践技能均有所提高,其药学服务能力同时得到提高。

Objective To analyze the application effectiveness of the “divided-comprehensive precepting” model in the hospital outpatient pharmacy and provide reference value for improving the teaching quality of pharmacy interns．Methods Forty-eight interns（including visiting scholars and graduate students）from the Pharmacy Department of Panyu Central Hospital in Guangzhou,China,from September 2020 to July 2022 were selected as the research subjects．The “divided-comprehensive precepting” model,characterized by “staged,tiered,diagnosis unit-specific window learning,and comprehensive competency development” was implemented for all interns．The scores of all interns before and after entering the internship were observed．Results After the implementation of the“divided-comprehensive precepting”model,the scores of interns in theoretical knowledge（94.15±3.38）and pharmaceutical service skills（90.56±3.99）were improved compared to those before the internship．Moreover,interns’scores in learning interest（94.21±3.70）,consolidating knowledge（91.98±3.56）,enhancing doctor-patient communication（92.73±3.81）and recognizing their own skill deficiencies（92.06±3.50）were also improved．Conclusions The “divided-comprehensive precepting” precepting model significantly enhances the teaching effectiveness in the internship of hospital outpatient pharmacy．Interns’ theoretical and practical skills are improved,enhancing their pharmaceutical service capabilities．

价值医疗下公立医院需转变运营管理模式,建设专门运营管理部门对满足外部政策要求和改善内部运营管理十分必要。通过梳理公立医院开展运营管理的主要任务,确定公立医院专门运营管理部门的职责,设计与承担职责相适应的组织架构,保证专门运营管理部门的职能充分发挥。

Public hospitals need to change the operation management mode under value-based healthcare．It is necessary to build a special operation management department to meet the requirements of external policies and improve internal operation management．By sorting out the operation and management tasks of public hospitals,the responsibilities of the operation management department are determined,and the organizational structure suitable for the responsibilities is designed,so that the construction of specialized operation management department can be effectively implemented．

目的 分析PDCA管理法在医院药事管理中的应用效果。方法 将我院2 000批药品设置为研究对象,样本纳入的起始、截止时间分别为2022年1月、2022年12月,依据时间对纳入样本开展组别划分,将2022年1月—6月1 000批药品设置为PDCA管理前研究对象,期间接受常规药品管理;将2022年7月—12月1 000批药品设置为PDCA循环法管理后研究对象。对比PDCA管理前后药品不良事件发生率及药事管理质量评分。结果 PDCA循环法管理后药学差错事件发生率低于PDCA循环法管理前,分别为0.30%、1.90%,对比差异有统计学意义（P<0.05）;PDCA循环法管理后建立药品质量监控体系、药品调剂制度、抗肿瘤药物分级管理方案和处方管理、临床药师参与四个维度评分较PDCA循环法管理前均有明显提升,分别为18.15±1.83、18.15±1.64、18.22±1.67、18.07±1.84,管理前后评分对比差异具有统计学意义（P<0.05）。结论 医院药事管理采用PDCA管理法可提升药事管理质量,降低药品不良事件发生率,值得应用。

Objective To analyze the application effect of PDCA cycle method in hospital pharmaceutical management．Methods A total of 2 000 batches of drugs in our hospital were included as research objects,the inclusion start and end of samples were January 2022 and December 2022．The included samples were divided into groups according to the time,1 000 batches of drugs from January 2022 to June 2022 were included as research objects before PDCA management,during which they were subjected to routine drug management．1 000 batches of drugs from July 2022 to December 2022 were included as the research objects under management by PDCA cycle method．The incidence of adverse drug events and the quality score of drug administration before and after PDCA administration were compared．Results The incidence of pharmaceutical error events after PDCA cycle management was lower than that before PDCA cycle management,which were 0.30% and 1.90%,respectively,and the differences were statistically significant（P<0.05）．After PDCA cycle management,the scores of establishment of drug quality control system（18.15±1.83）,drug dispensing system（18.15±1.64）,anti-tumor drug grading management scheme and prescription management（18.22±1.67）,clinical pharmacist participation（18.07±1.84）were significantly improved compared with those before PDCA cycle management,and the difference between scores before and after PDCA cycle management was statistically significant（P<0.05）．Conclusions PDCA cycle can improve the quality of pharmaceutical management and reduce the incidence of adverse drug events,which is worthy of application．

目的 分析流行性感冒（流感）患儿的流行病学特征及病原学分布。方法 纳入2020年3月—2023年2月在开封市祥符区第一人民医院确诊为流感的394例1~10岁患儿的咽拭子标本,通过实时荧光定量聚合酶链式反应完成流感病毒检测,分析此394例流感患儿感染的病毒类型及年龄、季节、性别、年份等分布情况。结果 甲型H1N1流感病毒为本次研究检出占比最高的流感病毒,占36.04%;男女患儿之间的甲型H3、甲型H1N1、乙型BV、乙型BY流感病毒占比比较差异无统计学意义（P>0.05）;春季及冬季流感患儿占比最多,分别为41.12%、35.53%,且不同季节之间的甲型H3、甲型H1N1、乙型BV、乙型BY流感病毒占比比较差异有统计学意义（P<0.05）;7~10岁流感患儿占比最高,为42.13%,不同年龄段患儿之间的甲型H3、甲型H1N1、乙型BV、乙型BY流感病毒占比比较差异无统计学意义（P>0.05）;2020年流感患儿占比最高,为43.40%,后续依次为2022年的29.70%,2021年的26.90%;不同年份的冬季流感患儿占比比较差异有统计学意义（P<0.05）;不同年份的各年龄段流感患儿占比比较差异无统计学意义（P>0.05）;各年甲型H3、甲型H1N1、乙型BV、乙型BY流感病毒占比比较差异无统计学意义（P>0.05）。结论 年龄7~10岁的患儿为流感高危群体,且甲型流感为患儿主要感染类型,而甲型流感病毒多见于春、冬季,新型冠状病毒肺炎疫情期间防控政策变化对流感流行有影响,应加强春、冬季7~10岁年龄段患儿的甲流预防工作。

Objective To analyze the epidemiological characteristics and etiological distribution of children with influenza（flu）．Methods The throat swab specimens of 394 children aged 1 to 10 years old who were diagnosed with influenza at the First People's Hospital of Xiangfu District,Kaifeng City from March 2020 to February 2023 were included．The samples were analyzed by real-time fluorescence quantitative polymerase chain reaction to complete influenza virus detection and analyze the virus types and distribution of age,season,gender,year,etc．among these 394 children with influenza were analyzed．Results Influenza A H1N1 virus was the influenza virus with the highest proportion detected in this study,accounting for 36.04%;there were differences in the proportions of influenza A H3,A H1N1,BV,and B BY influenza viruses between male and female children,with no statistical significance（P>0.05）;the proportion of children with influenza is the largest in spring and winter,41.12% and 35.53% respectively,and proportions of influenza A H3,A H1N1,B BV,and B BY influenza in different seasons were significantly different（P<0.05）．Children aged 7 to 10 accounted for the highest proportion of influenza patients,42.13%．Among children of different ages,the proportion of influenza A H3,A H1N1,B BV,B BY had no statistically significant difference（P>0.05）．The proportion of children with influenza in 2020 was the highest at 43.40%,followed by 29.70% in 2022 and 26.90% in 21;in different years there is a statistically significant difference in the proportion of children with influenza in winter（P<0.05）．There is no statistically significant difference in the proportion of children with influenza of all ages in different years（P>0.05）．The preportions of influenza A H3 and A H1N1,B BV and B BY viruses in each year,had no statistically significant difference（P>0.05）．Conclusions Children aged 7 to 10 years old are a high-risk group for influenza,and influenza A is the main type of infection in children．Influenza A viruses are more common in spring and winter．Changes in prevention and control policies during the new coronavirus pneumonia epidemic have an impact on the epidemic of influenza．Therefore,prevention of influenza A for children aged 7 to 10 years old in spring and winter should be strengthened．

在“放管服”改革的背景下,基于业财融合管理理念对医院科研物资进行一体化管理是发展趋势。但由于科研项目管理涉及众多部门,流程繁杂,致使医院科研物资管理面临诸多问题。为了改变现状,广州市某三甲医院探索构建基于业财融合的医院科研物资一体化信息系统,分别上线了科研物资采购平台和经费管理系统,并在实践中对信息系统进行了优化与设计。实践证明,该系统具有创新性和应用价值,对医院的财务管理和科研项目管理具有重要的参考意义。

Under the background of streamlining administration and delegating power,the integrated management of hospital scientific research materials based on the concept of integrating industry and finance is a development trend．However,due to the involvement of multiple departments and complicated processes in scientific research project management,the management of hospital scientific research materials faces many problems．In order to change the current situation,a Tertiary Grade A Hospital in Guangzhou explored the construction of an integrated information system for hospital scientific research materials based on the integration of industry and finance．They launched a scientific research material procurement platform and a funding management system,and optimized and designed the information system in practice．Practice has proven that the system is innovative and valuable,and it has important reference significance for the financial management and scientific research project management of hospitals．