伴随着对医疗领域人才水平要求的逐步提高,医院人力资源管理尤其是医院人才引进工作正在由规模化发展向精细化发展转变。当前医院人才引进过程中存在缺乏人力资源发展规划、高层次人才引进方法有待完善、人才管理能力亟须提高、科室用人需求脱离实际、忽视对于岗位胜任力的分析等问题。人力资源成熟度模型（People Capability Maturity Model,P-CMM）作为一种系统的管理理论,其具备很强的实践性,文章对人力资源成熟度模型在医院人才引进工作中的本土化应用进行相关讨论与研究,将P-CMM不同成熟度等级、过程域目标与医院人才引进工作相结合,并提出可操作性指导,具有一定的理论与实践价值。

With the gradual improvement of the requirements for talents in the medical field,hospital human resource management,especially the introduction of talents in hospitals,is changing from large-scale development to refined development．At present,there are some problems in the process of hospital talent introduction,such as lack of human resource development plan,improvement of high-level talent introduction method,improvement of talent management ability,separation of department employment demand from reality,neglect of post competency analysis,etc．People Capability Maturity Model（P-CMM）,as a systematic management idea,has strong practicality．This study discusses and studies the localization application of human resource maturity model in hospital talent introduction,combines different maturity levels and process area objectives of P-CMM with hospital talent introduction,and puts forward operational guidance It has certain theoretical and practical value．

目的 探讨住院儿童甲型流感病毒肺炎合并其他病原菌感染的临床特征。方法 通过回顾性研究方法,分析2021年6月—2023年6月广州市妇女儿童医疗中心住院治疗的153例甲型流感病毒肺炎患儿的临床资料,针对有无合并其他病原菌感染,分为混合感染组及非混合感染组两组,分别为98例及55例,分析并对比两组的临床特征。结果 甲型流感病毒肺炎患儿以发热、咳嗽、呕吐/腹泻等症状为主,其中混合感染组患儿呕吐/腹泻症状占比高于非混合感染组（P<0.05）;两组患儿其他症状及并发症对比差异无统计学意义（P>0.05）;儿童甲型流感病毒肺炎患儿检出合并细菌感染的患儿65例（29.41%）,合并肺炎支原体感染的患儿33例（21.57%）;合并病毒感染的患儿20例（13.07%）。与非混合感染组比较,混合感染组患儿乳酸脱氢酶水平更高,白细胞计数<4×10⁹/L的人数占比更少（P<0.05）;其他实验室指标对比差异无统计学意义（P>0.05）;经过抗病毒及对症治疗后,150例（98.04%）患儿痊愈出院,3例出现严重并发症,其均伴有其他病原菌感染。与非混合感染组比较,混合感染组患儿住院天数更长、住院费用更高（P<0.05）;其他预后指标对比差异无统计学意义（P>0.05）。结论 甲型流感病毒肺炎患儿易感染其他的病原菌,导致疾病治疗难度加大,因此临床要提高警惕,以防混合感染情况发生,尽早采取有效的诊治措施,提高疾病早期治愈率。

Objective To explore the clinical characteristics of hospitalized children with influenza A virus pneumonia complicated with other pathogens．Methods The clinical data of 153 children with influenza A virus pneumonia hospitalized in Guangzhou Women and Children Medical Center in the past two years（June 2021 ~ June 2023）were analyzed retrospectively． According to whether they were infected with other pathogens,they were divided into mixed infection group and non-mixed infection group,with 98 cases and 55 cases respectively．The clinical characteristics of the two groups were analyzed and compared．Results Fever,cough,vomiting and diarrhea were the main symptoms in children with influenza A virus pneumonia,and the proportion of vomiting and diarrhea in children with mixed infection group was higher than that in children without mixed infection group（P<0.05）．There was no significant difference in other symptoms and complications between the two groups（P>0.05）．There were 65 children（29.41%）with influenza A virus pneumonia and 33 children（21.57%）with mycoplasma pneumonia,20 children（13.07%）with virus infection．Compared with non-mixed infection group,the level of lactate dehydrogenase in children with mixed infection group was higher,and the proportion of children with white blood cell count<4×10⁹/L was less（P<0.05）．There was no significant difference in other laboratory indexes（P>0.05）．After antiviral and symptomatic treatment,150 cases（98.04%）were cured and discharged,and 3 cases had serious complications,all of which were accompanied by other pathogens．Compared with non-mixed infection group,children in mixed infection group had longer hospitalization days and higher hospitalization expenses（P<0.05）．There was no significant difference in other prognostic indicators（P>0.05）．Conclusions Children with influenza A virus pneumonia are easily infected with other pathogens,which makes it more difficult to treat the disease．Therefore,we should be vigilant in clinic to prevent mixed infection and take effective diagnosis and treatment measures as soon as possible to improve the early cure rate of the disease．

目的 调查护理人员对预防跌倒知识掌握的情况,以提高其对防跌倒相关知识的认知水平,减少住院患者跌倒的发生。方法 用自编住院患者跌倒相关知识掌握量表对护理人员进行问卷调查。结果 护理人员对跌倒知识的掌握正确率最高为跌倒分级64.04%、最低为跌倒后干预措施17.10%。外科护理人员对患者跌倒风险评估时机的把握为88.69%,妇儿科护理人员的正确率（71.11%）高（χ²=21.319,P=0.003）,住院患者发生跌倒后的处理正确率急诊为76.67%,高于门诊的42.67%（χ²=27.651,P<0.001）;在把握患者跌倒风险评估的时机方面工作年限<5年的护理人员为 89.81%,比工作年限>20年的护理人员（64.15%）更容易把握患者跌倒风险评估的时机（χ²=18.921,P<0.001）,工作年限11~20年的护理人员对住院患者预防跌倒的干预措施正确率为24.66%,比工作年限<5年的护理人员（11.46%）高（χ²=9.678,P=0.022）;工作年限>20年的护理人员对住院患者发生跌倒后的处理正确率为58.49%比工作年限<20年以下的护理人员（34.25%）高（χ²=12.787,P=0.005）。结论 护理人员跌倒预防相关知识掌握度总体较低,应加强对护理人员关于患者跌倒预防知识的系统培训,减少住院患者跌倒的发生。

Objective To investigate the mastery of falls prevention knowledge among nursing staffs,in order to improve their cognitive level of falls prevention related knowledge and reduce the occurrence of falls in hospitalized patients．Methods A questionnaire survey was conducted among nursing staffs with a self-designed questionnaire on the mastery of falls related knowledge among hospitalized patients．Results The highest accuracy rate of nursing staffs' mastery of falls knowledge was 64.04% for falling classification,and the lowest was 17.10% for falls intervention measures．Nursing staffs' accuracy of the timing of patient fall risk assessment was 88.69% in surgery,which was higher than 71.11% in nursing staff in obstetrics,gynecology,and pediatrics（χ²=21.319,P=0.003）．The accuracy of emergency treatment for hospitalized patients after falls was 76.67%,which was higher than 42.67% in outpatient treatment（χ²=27.651,P<0.001）．The accuracy of the timing of patient fall risk assessment in nursing staffs with less than 5 years of work experience was 89.81%,which was better than nursing staff with more than 20 years of work experience（64.15%）（χ²=18.921,P<0.001）．Nursing staff with 11-20 years of work experience had a correct intervention rate for preventing falls in hospitalized patients of 24.66%,which was higher than nursing staffs with less than 5 years of work experience（11.46%）（χ²=9.678,P=0.022）．The accuracy rate of handling falls in hospitalized patients by nursing staffs with more than 20 years of work experience was 58.49%,which was higher than that of nursing staff with less than 20 years of work experience,which is 34.25%（χ²=12.787,P=0.005）．Conclusions Overall,nursing staff had a low level of falls prevention knowledge,and systematic training on patient fall prevention should be strengthened to reduce the occurrence of falls in hospitalized patients．

目的 探讨不同年龄段皮罗序列征患儿血气分析的特点、手术后机械通气时间和住院时间。方法 收集新生儿及非新生儿III度皮罗序列征(PRS)患儿各30例,PRS患儿入院后通过桡动脉进行采集血标本进行血气分析,比较2组血标本的 pH 值、PCO₂ 、PO₂ 、HCO^-₃、BE、乳酸、AG、A-aDO₂的特点、手术后机械通气时间及住院时间。结果 新生儿组PCO₂、HCO^-₃、BE、乳酸及A-aDO₂高于非新生儿组,非新生儿组PO₂及AG高于新生儿组。2组pH值、PO₂、AG均在正常范围,机械通气及住院时间与乳酸呈正相关,与年龄呈负相关。结论 不同的年龄阶段,PRS患儿的动脉血气分析的结果不同,高乳酸与低年龄PRS患儿手术后机械通气时间及住院时间长。

Objective To investigate the characteristics of arterial blood gas analysis, time of mechanical ventilation and hospital stay in different age patients with Pirre Robin sequence (PRS). Methods Sixty children with III-grade PRS were divided into two groups according to their age, as neonate group and non-neonate group. The blood samples were collected from radial artery after admission for blood gas analysis, the characteristics of pH value, partial pressure of carbon dioxide (PCO₂), partial pressure of blood oxygen (PO₂), bicarbonate ion (HCO^-₃), base excess (BE), lactic acid (Lac), anion gap (AG) , alveolar artery oxygen pressure difference (A-aDO₂) , postoperative mechanical ventilation time and hospital stay were compared between the two groups. Results The levels of PCO₂, HCO^-₃, BE, Lac and A-aDO₂ in neonate group were higher than those in non-neonate group, and the levels of PO₂ and AG in non-neonate group were higher than those in neonate group. The pH value, PO₂ and AG of the two groups were in the normal range. Post-operative mechanical ventilation time and hospital stay were positively correlated with Lac and negatively correlated with age. Conclusions In different age groups, the results of arterial blood gas analysis in PRS children were different, and the time of mechanical ventilation and hospital stay were longer in higher Lac level and younger patients with PRS.

目的 了解急诊科综合病区患者疾病分类构成的特点,为护士进行有针对性的培训,并为合理调配护理人员提供依据。方法 对2020年1月—2021年12月我院急诊科综合病区收治的1 901例患者疾病分类、收治时间等进行回顾性调查分析。结果 研究期间急诊综合病区共收治患者1 901例,收治患者以呼吸系统的患者居多,占比47.71%;以循环系统疾病的患者平均发病年龄最高,为(66.434±11.691)岁;全年各月以1月、12月收治病人居多。结论 根据调查分析,有针对性地对护士进行呼吸系统疾病护理技能培训,并在收治高峰期,合理调配护理人员,实施弹性排班,保障患者安全,提高护理质量。

Objective To understand the characteristics of disease classification and composition of patients in Comprehensive Ward of Emergency Department, provide targeted training for nurses, and provide basis for rational deployment of nursing staff. Methods A total of 1 901 patients in the Comprehensive Ward of Emergency Department of our hospital from January 2020 to December 2021 were investigated and analyzed retrospectively according to different diseases and time of admission. Results A total of 1 901 patients were treated in the Emergency Comprehensive Ward during the study period. Most of the patients were with respiratory system disease, accounting for 47.71%. The average onset age of patients with circulatory diseases was the oldest, which was (66.434±11.691). Most patients were admitted in January and December. Conclusions According to the investigation and analysis, nurses should be trained with the skills of respiratory diseases nursing, nursing staff should be reasonably allocated and flexible shift should be scheduled during the peak period of admission, so as to ensure the safety of patients and improve the quality of nursing.

目的 比较早产胎膜早破(PPROM)≥34周的肥胖孕妇与非肥胖孕妇的早产儿住院结局。方法 回顾性分析2016年1月—2020年12月在本院出生并入住新生儿科的所有出生胎龄≥34周的PPROM早产儿。根据孕妇分娩时体质量指数(BMI),分为肥胖组(BMI≥30 kg/m²)和非肥胖组(BMI＜30 kg/m²),比较2组间的一般情况、妊娠结局及所生晚期早产儿的住院结局,组间比较采用两独立样本t检验及χ²检验。结果 与非肥胖孕妇相比,肥胖孕妇的晚期早产儿分娩后呼吸道并发症发病率高,主要表现为新生儿呼吸窘迫综合征,辅助通气、吸氧和表面活性物质的使用、败血症、感染性肺炎发病率高,母亲妊娠期糖尿病发病率增高,差异均具有统计学意义(P＜0.05),其余新生儿高胆红素血症、新生儿坏死性小肠结肠炎、脑室内出血、早产儿支气管肺发育不良等并发症比较无统计学意义(P＞0.05)。结论 PPROM≥34周的肥胖孕妇与非肥胖孕妇相比,所生晚期早产儿呼吸道并发症和败血症等不良结局的发生率增加。

Objective To compare the hospitalization outcomes of 34 weeks or over preterm infants with preterm premature rupture of membranes (PPROM) in obese and non-obese pregnant women. Methods A retrospective analysis of PPROM preterm infants born in our hospital and admitted to the neonatology department from January 2016 to December 2020 with a gestational age of 34 weeks or over was carried out. According to the pregnant women's body mass index (BMI) at delivery, they were divided into obese group (BMI≥30 kg/m²) and non-obese group (BMI<30 kg/m²). The general conditions, pregnancy outcomes and late premature infants hospitalization outcomes between the two groups were compared using two independent samples t test and χ² test. Results Compared with non-obese pregnant women, the incidence of respiratory complications after delivery in late preterm infants of obese pregnant women was higher, mainly manifested as high incidence of neonatal respiratory distress syndrome, assisted ventilation, oxygen inhalation and the use of surfactants, sepsis, and pneumonia, also maternal gestational diabetes incidence was increased, and the differences were statistically significant (P<0.05); other complications of neonatal hyperbilirubinemia, necrotizing enterocolitis, intraventricular hemorrhage, bronchopulmonary dysplasia were not statistically significant (P>0.05). Conclusions Compared with non-obese pregnant women with 34 weeks or over PPROM, obese pregnant women had an increased incidence of adverse outcomes in late preterm infants such as respiratory complications and sepsis.

目的 探讨医院消毒供应中心清洗全程质量控制用于院内感染风险预防价值。方法 选取2019年1月—2021年6月期间医院消毒供应中心待清洗消毒的1 000件手术器械（观察组）,采用全程质量控制;另选取1 000件手术器械（对照组）,常规流程清洗;比较2组患者器械清洗质量,统计清洗后因术中器械的院内感染率。结果 观察组清洗消毒后器械血渍、污垢、锈斑总发生率0.20%,低于对照组的1.50%,器械清洗、消毒、灭菌合格率高于对照组（P<0.05）。观察组器械操作流程与标准、科室管理、安全管理、综合质量管理高于对照组,院内感染率0.10%低于对照组的1.00%,医护人员满意度95.00%高于对照组的75.00%（P<0.05）。结论 医院消毒供应中心清洗质量控制,可增加手术器械清洗质量,减少院内感染的发生。

Objective To explore the value of whole process cleaning quality control in hospital disinfection supply center for risk prevention of hospital infection．Methods From January 2019 to June 2021,1000 surgical instruments to be cleaned and disinfected in the hospital disinfection supply center（observation group）were selected,and the whole process quality control was applied;another 1000 surgical instruments（control group）were selected for routine cleaning．The quality of instrument cleaning in the two groups was compared,and the hospital infection rate after the application of cleaned instrument was calculated．Results After cleaning and disinfecting instruments,the total incidence of blood stains,dirt and rust was 0.20% in the observation group,lower than that in the control group,which was 1.50%,and the qualified rate of instrument cleaning,disinfecting and sterilizing was higher than that in the control group（P<0.05）．The equipment operation procedures and standards,department management,safety management,and comprehensive quality management of the observation group were higher than those of the control group,the hospital infection rate was 0.10%,lower than that of the control group（1.00%）,and the satisfaction rate of medical staff was 95.00% in the observation group,higher than that of the control group（75.00%,P<0.05）．Conclusions The cleaning quality control of hospital disinfection supply center can improve the cleaning quality of surgical instruments and reduce the occurrence of hospital infection.

目的 从社会组织网络嵌入性的角度,探讨公立医院医务人员工作内外匹配（包括组织匹配和区域匹配）在人际信任与隐性医学知识共享行为之间的中介效应,完善公立医院医务人员隐性医学知识共享机制的研究。方法 采用问卷调查方式对公立医院医务人员进行调查,运用SPSS 17.0软件进行数据分析,采用AMOS 22.0建立公立医院医务人员工作内外匹配在人际信任与隐性医学知识共享行为之间的中介效应回归方程。结果 公立医院医务人员人际信任与隐性医学知识共享行为之间有显著的正相关关系,标准化回归系数为0.446（P <0.001）。加入工作内外匹配变量后,公立医务人员人际信任对隐性医学知识共享行为的标准化回归系数由0.446（P <0.001）降到0.189（P<0.01）。结论 公立医务人员人际信任正向预测隐性医学知识共享行为;组织匹配、区域匹配在公立医务人员人际信任与隐性医学知识共享行为之间具有部分中介效应。

Objective To explore a new path of interpersonal trust impact on knowledge sharing behavior-being from the perspective of job embeddedness．Methods Questionnaire survey was used to investigate the medical staff in public hospitals．SPSS 17.0 software was used to analyze the data．AMOS 22.0 was used to establish the regression equation of intermediary effect between interpersonal trust and tacit medical knowledge sharing behavior of medical staff in public hospitals．Results There was a significant positive correlation between interpersonal trust and tacit medical knowledge sharing behavior．The standardized regression coefficient was 0.446（P <0.001）．When added the fitting to organization and community,the standardized regression coefficient decreased from 0.446（P <0.001）to 0.189（P <0.01）．Conclusions The interpersonal trust of public medical staffs positively predicts the tacit medical knowledge sharing behavior．Organizational matching and regional matching have partial mediating effect between interpersonal trust and tacit medical knowledge sharing behavior of public medical staff.

目的 分析华北地区某医院院前急救医疗服务的资源利用状况,并依据相关影响因素针对院前急救医疗服务过程中存在问题提出相应对策。方法 收集2021年3月—2022年4月期间就诊于华北地区某医院急诊科患者的一般资料、就诊过程、症状特征。依据是否接受过院前急救服务、是否为疾病急性发作的危重症患者将患者分为4组,分析比较4组患者在一般资料、疾病病症特点两个方面是否存在统计学差异,探索影响院前急救医疗资源合理利用的相关因素。结果 本研究总计收纳患者病例5 800例,其中接受院前急救医疗服务的患者共840例占总调查人数的14.5%,其中危重症患者530例（63.1%）,非危重症患者310例（36.9%）;未接受院前急救医疗服务的患者为4 960例占总调查人数的85.5%,其中危重症患者803例（16.2%）。对所得数据采用多因素回归方法分析得知,在急诊科接受的危重症患者中急性胸痛与突发性头痛是选择不使用院前急救医疗措施的独立影响因素。在非危重症患者中发热、外伤、腹痛是非急重症患者接受院前急救医疗服务的独立影响因素。结论 院前急救医疗服务资源的提供与利用在实际应用的过程中存在资源闲置与服务空缺的问题。危重症患者在入院前仍有较大比例的患者没有选择接受院前急救医疗服务。该情况表明当前居民对危重症患者危重症状及院前急救医疗服务了解与认知不足,对此有必要加强对居民关于院前急救服务的科普宣教工作,并借助现有医疗服务力量支持院前急救医疗服务的规范与准则,这对保障患者生命安全,争取危重症患者存活机会,促进急救资源合理利用具有重要意义。

Objective To analyze the resource utilization status of pre-hospital emergency medical services in a hospital in North China,and to propose corresponding countermeasures for problems in the process of pre-hospital emergency medical services according to relevant influencing factors．Methods From March 2021 to April 2022,the general data,treatment process and symptom characteristics of patients who were treated in the emergency department of a hospital in North China were collected．According to whether they had received pre-hospital emergency services and whether they were critically ill patients with acute onset of disease,the patients were divided into four groups．Whether there were statistical differences in the general data and disease characteristics of the four groups of patients,and the relevant factors affecting the rational utilization of pre-hospital emergency medical resources were explored．Results This study included 5 800 patients,of which 840 patients receiving pre-hospital emergency medical services,accounted for 14.5% of the total survey,including 530（63.1%）and 310 non-critically ill patients（36.9%）;4 960 patients not receiving pre-hospital emergency medical services accounted for 85.5% of the total survey,including 803（16.2%）of critically ill patients．Analysis by multivariate regression methods on the obtained data showed that acute chest pain and sudden headache in critically ill patients in the emergency department were independent influencing factors in choosing not to use pre-hospital emergency medical measures．Fever,trauma,and abdominal pain in non-critically ill patients were independent factors influencing the reception of pre-hospital emergency medical services．Conclusions The provision and utilization of pre-hospital emergency medical service resources have the problem of idle resources and service vacancies in the process of practical application．A significant proportion of critically ill patients still do not choose to receive pre-hospital emergency medical services before admission．This situation shows that the current residents have insufficient understanding and cognition of critical symptoms and pre-hospital emergency medical services,and it is necessary to strengthen the scientific popularization and education of residents on pre-hospital emergency services,and support the norms and guidelines of pre-hospital emergency medical services with the help of existed medical services,which is of great significance for ensuring the safety of patients' lives,striving for the survival opportunities of critically ill patients,and promoting the rational use of emergency resources．

目的 通过静脉输液批次决策的自动化、标准化以及个体化,实现静脉用药调配中心（PIVAS）工作同质化和高效化,进而促进临床安全合理用药。方法 根据药物使用的时辰药理学,调查分析人工决策输液批次存在的问题,建立批次时间划分表和制定批次决策规则,基于医院信息系统构建自动输液批次决策系统。由药师维护自动输液批次决策系统,针对该系统的应用效果评价分析。结果 应用自动批次决策软件后,PIVAS 批次不合格率下降,输液时间合理性提高。审方药师用于决策输液批次的时间减少,大幅度提高 PIVAS 和病区护士工作效率,同时降低 PIVAS输液配送出错频率。结论 自动输液批次决策系统构建完成之后,用药时间更合理,提高药物治疗效果;PIVAS工作效率明显提高,工作质量显著提升,输液批次不合格率降低,患者输液批次真正做到编排一致性,提高用药时间合理性,进而使临床用药更合理、更安全,实现个体化治疗。

ObjectiveThrough the automation, standardization and individualization of intravenous（IV）fluid batch decision-making, to realize the homogenization and high efficiency of Pharmacy Intravenous Admixture Services（PIVAS）, to promot safe and rational clinical drug use．Methods According to the pharmacology of drug use, the problems existing in manual IV fluid batch decision were investigated and analyzed, and an automatic IV fluid batch decision system was constructed based on hospital information system．Batch time division table and batch decision rules were established, automatic IV fluid batch decision system was maintained by pharmacists, the application effect of the system were evaluated and analyzed．Results The unqualified rate of PIVAS batch decreased, and the rationality of IV transfusion time increased．The time for prescription checking pharmacists to make IV fluid batch decisions was shortened, which greatly improved the work efficiency of PIVAS and nurses, and reduced the error frequency of PIVAS IV fluid distribution．Conclusions After the completion of the automatic IV fluid batch decision system, the medication time is more reasonable and the drug treatment effect is improved．The work efficiency and quality of PIVAS are significantly improved, and the unqualified rate of IV fluid batches is reduced．The IV fluid batches of patients are really arranged in a consistent way, and the rationality of medication time is improved, so that clinical medication is more reasonable and safer, and individualized treatment is realized．