ABSTRACT
OBJECTIVE To further improve the rational drug use control mechanism based on performance appraisal， explore new paths of pharmaceutical care and promote the rational clinical drug use management to deepen development. METHODS The reform of pharmaceutical management system in our hospital was performed through implementing the “ten-point system of prescription behavior management”， supplemented by the two carriages of “strengthening prescription review” and “standardizing clinical medication”. By implementing a number of auxiliary measures such as man-machine integration pre-prescription review， improving pharmacists’ prescription review ability， optimizing prescription review mechanism in real time， regulating physicians’ off-label drug use behavior， and improving drug evaluation mechanism， pre-control and in-process intervention were completed. The evaluation results were incorporated into performance assessment by referring to the “ten-point system of prescription behavior management”， so as to realize multi-dimensional and fully closed-loop rational drug use management. The effects of management were evaluated by comparing the statistical results of related indexes before and after the management. RESULTS Compared with before management， irrational rate of prescriptions and medical orders in our hospital in 2022 decreased significantly， compared to the same period in 2020； the irrational rate of inpatient medical orders decreased from 5.00% in 2020 to 2.69% in 2022， and that of outpatient prescriptions decreased from 4.59% to 2.48%； the frequency of communication between clinical pharmacists and physicians increased； the times of clinical consultations increased from 16 to 58， and doctors’ acceptance of intervention for irrational drug use had improved from 52％ to 87％ ； physicians had a deeper understanding and recognition of clinical pharmaceutical care， the awareness of clinical rational drug use had been significantly improved. CONCLUSIONS The rational drug use control mechanism guided by performance appraisal further standardizes the issuance of prescriptions and medical orders， and makes physician-pharmacist cooperation more prominent， so as to realize the closed-loop pharmaceutical management of “pre- review， in-process supervision and post-evaluation”， and promote rational drug use in clinical practice.
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DRGs is one of the most advanced methods of payment in the world.It can control the unreasonable growth of medical expenses to a certain extent.China has also began to explore DRGs payment methods,and has tried to play an active role in medical insurance cost control.Compared with foreign DRGs,Chinese DRGs has a unique cost control mechanism,and its cost control effect will be affected by many environmental variables.
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The paper analyzed the internal causes of the corruption risk control mechanism at public hospitals in China. Based on the current development of such mechanism, the authors proposed such measures as pre-warning, intermediate supervision and follow-up actions against the corruption risk exposure commonly found at such hospitals. These efforts aim at further improvement of the corruption risk control of the hospitals.
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Desde la perspectiva histórico-cultural, el trastorno por déficit de atención (TDA) se asocia con la inmadurez del factor de programación y control, que involucra el funcionamiento de regiones frontales del cerebro y hace parte del sistema ejecutivo. El artículo aborda un estudio de caso clínico en el que se exploró el impacto sistémico de un programa de intervención breve basado en el análisis del factor neuropsicológico, para comprobar su efectividad y eficiencia en el manejo sintomatológico del (TDA) y para proponer nuevos estudios controlados y aleatorizados que eventualmente validen esta metodología. Para lograrlo, se describieron los alcances del programa de corrección neuropsicológica orientada al fortalecimiento del factor de regulación y control mediante el desarrollo de la función reguladora del lenguaje, para incrementar las capacidades de planeación, control de espera, de autoverificación y la atención voluntaria. La intervención se basó en un diseño de línea de base múltiple tipo A-B-A, cuyos resultados se analizaron a partir de los puntajes de pruebas normalizadas y del análisis cualitativo de sus ejecuciones, realizadas al inicio del estudio y seis meses después. El caso analizado mostró un fortalecimiento de la función reguladora del lenguaje que impactó el desarrollo de los procesos psicológicos ejecutivos y se tradujo en un incremento del control atencional voluntario, la regulación de espera y la capacidad de planeación. Se concluye que el resultado de este caso ubica a este método como alternativa de manejo del (TDA) susceptible de ser estudiada en mayores grupos poblacionales controlados para validar el resultado, y eventualmente ofrecer un manejo extrapolable a la población diagnosticada.
From a cultural-historical perspective, attention deficit disorder (ADD) is associated with immaturity factor programming and control, which involves the functioning of the brain's frontal region and makes part of the executive system. This paper presents a clinical case study in which the systemic impact of a brief intervention program was explored; such intervention was based on the neuropsychological factor analysis, in order to prove its effectiveness and efficacy at ADD's management of symptoms as well as to propose new controlled and random studies to eventually validate this methodology. To achieve this, we described the scope of the program oriented neuropsychological correction factor strengthening the regulation and control, by developing the regulatory function of language, in order to improve planning, control of waiting, self-check and voluntary attention. Intervention was supported on an A-B-A multiple base line design, whose results were analyzed from the scores of standardized tests and the qualitative analysis of its performances at the beginning and six months after. The case analyzed showed a strengthening in the regulatory function of language, which affected the development of the executive psychological processes and showed an increase in the voluntary attentional control, regulation of waiting and planning ability. In conclusion, the result of this case places this method as an alternative to manage ADD, susceptible to be studied in larger controlled groups in order to validate the result and eventually offering an extrapolated management to a population diagnosed.
Subject(s)
Attention Deficit Disorder with Hyperactivity , Language , NeuropsychologyABSTRACT
Discussion on the construction of medical dispute prevention and control mechanism from the per -spective of crisis management and the ethical thinking are conducive to the effective prevention , control and solution of medical disputes .This can promote the healthy development of the doctor -patient relationship and has the im-portant value of ethics .At present , should strengthen the crisis management from the aspect of ethics to control medical disputes in the following aspects: establishing the medical dispute crisis -prevention mechanism by strengthening the training of medical staff′s medical ethics and medical skill;establishing the medical dispute crisis-resolution mechanism under the principle of respect for life and the patient first;establishing the medical dispute crisis assessment and post -processing mechanism around the idea of love , gratitude , and excellence development .
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Through settling the responsibilities of key positions’ and process system, West China Hospital’s financial department finds out the incorrupt government risks that may exist in the positions, process and the system, makes effective risk prevention and control measures, and gradually forms a complete and clear concept and system of the risk prevention and control, which can effectively monitor the operation and ensure the long-term healthy development of the hospital.
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rgency response mechanism in place;and effective research work.