Qualidade do acesso percebida por usuários de serviços especializados em HIV/AIDS da Bahia, Brasil / Quality of access perceived by users of HIV/AIDS specialized services in Bahia, Brazil / Calidad de acceso percibida por los usuarios de servicios especializados en VIH/SIDA en Bahía, Brasil

Este artigo descreve o acesso e a percepção do acesso de usuários a serviços especializados no tratamento do vírus da imunodeficiência humana e da Síndrome da Imunodeficiência Humana (HIV/AIDS) em municípios baianos por meio de um recorte epidemiológico descritivo-analítico, com abordagem quantitativa de dados primários de estudo realizado em cinco serviços localizados na capital e oito no interior do estado da Bahia, Brasil. Participaram deste estudo 475 usuários, de 21 municípios baianos, predominantemente do sexo feminino, com faixa etária entre 25 e 44 anos, negros, cristãos, desempregados, com escolaridade compreendendo o ensino fundamental, renda de até três salários mínimos, heterossexual e cisgênero. O acesso à testagem para HIV e outras Infecções Sexualmente Transmissíveis (IST), profilaxias de pós-exposição e pré-exposição e outros insumos de prevenção não constituíram motivação de inserção no serviço. O tratamento específico e a assistência médica para HIV e outras IST foi motivação para que a maioria dos participantes se direcionassem ao serviço especializado. O deslocamento até o serviço de referência é realizado principalmente por transportes coletivos, e o trajeto casa-serviço tem duração de pelo menos uma hora. O horário de funcionamento da unidade atende às necessidades da maior parte dos participantes, mas parcela dos usuários mencionaram o desejo de funcionamento em horários alternativos. A marcação de consultas é realizada principalmente de forma presencial e por telefone, com possibilidade de agendamento diário, assim a maioria dos usuários avaliaram a organização do serviço para marcação de consultas como boa ou muito boa. O tempo de espera, entre marcação e consulta, mais comum é de uma semana a um mês.

This article describes user access and perception of access to specialized HIV/AIDS services in Bahia municipalities by applying a qualitative epidemiological, descriptive-analytical approach to primary data from research conducted in five services located in the capital and eight in the countryside. A total of 475 users from 21 municipalities in Bahia participated in this study. Most were female, between 25 and 44 years old, Black, Christian, unemployed, with complete primary education, income of up to 3 minimum wages, heterosexual and cisgender. Access to HIV testing and other STIs, post-exposure and pre-exposure prophylaxis and other prevention inputs did not constitute motivation for procuring the service. Specific treatment and medical care for HIV and other STIs motivated most participants to turn to specialized services. Commuting to the reference service is made mainly by public transport and the home-service journey takes at least one hour. The unit's opening hours meet the needs of most participants, but some mentioned the desire for alternative operating times. Appointments are booked mainly in person and over the phone, with the possibility of daily scheduling, so most users rated the service organization for scheduling appointments as good or very good. The most common waiting time between booking and consultation is one week to one month.

Este artículo describe el acceso y la percepción de acceso de los usuarios a servicios especializados en el tratamiento del virus de inmunodeficiencia humana y síndrome de inmunodeficiencia humana (VIH/sida) en municipios de Bahía (Brasil) mediante un enfoque epidemiológico, descriptivo-analítico, y un enfoque cuantitativo de datos primarios de un estudio realizado en cinco servicios ubicados en la capital y ocho en el interior del estado de Bahía. Participaron en este estudio 475 usuarios, de 21 municipios de Bahía, con mayor predominio femenino, con edades de entre 25 y 44 años, negros, cristianos, desempleados, con educación primaria, ingresos de hasta tres salarios mínimos, heterosexuales y cisgénero. El acceso a pruebas de VIH y otras infecciones de transmisión sexual (ITS), profilaxis posexposición y preexposición, y otros insumos de prevención no constituyeron una motivación para ingresar al servicio. El tratamiento específico y la asistencia médica para el VIH y otras ITS fueron la razón para que la mayoría de los participantes buscaran servicios especializados. El desplazamiento al servicio de referencia se realiza principalmente en transporte público, y el trayecto desde el domicilio al servicio tiene una duración mínima de una hora. El horario de atención de la unidad satisface las necesidades de la mayoría de los participantes, pero algunos usuarios mencionaron el deseo de que operase en horarios alternativos. Las citas se realizan principalmente de forma presencial y telefónica, con posibilidad de concertación diaria, por lo que la mayoría de los usuarios valoran como buena o muy buena la organización del servicio de citas. El tiempo de espera más habitual entre la reserva y la consulta es de una semana a un mes.

Clima organizacional y gestión de la calidad en la Universidad Mayor de San Andrés Caso: División de títulos y diplomas / Organizational climate and quality management at the Major University of San Andrés Case: Division of degrees and diplomas / Gestão do clima organizacional e da qualidade na principal Universidade de San Andrés Caso: Divisão de graus e diplomas

El propósito del trabajo fue determinar la relación existente entre el clima organizacional y la gestión de la calidad en la División de Títulos y Diplomas (DTD), unidad administrativa de la Universidad Mayor de San Andrés (UMSA), institución pública y autónoma, responsable de la formación académica profesional, investigativa y social en la ciudad de La Paz. Para ello se empleó una metodología cuantitativa y un diseño correlacional transaccional; se elaboraron tres escalas que fueron validadas y confiabilizadas para luego ser aplicadas a funcionarios y usuarios de la DTD (seleccionados a través de muestras probabilísticas simples y censal); se contó también con una guía de entrevistas. Los resultados arrojan que en la DTD se cuenta con un clima organizacional participativo en el que resaltan el liderazgo, el trabajo en equipo y una visión positiva sobre sueldos y prestaciones recibidas; como debilidades resaltan el ambiente físico de trabajo, el diseño de puestos de trabajo y el desarrollo de carrera. La certificación en gestión de calidad es la mayor fortaleza a lo que se suma la orientación al cliente; la debilidad en gestión de calidad está centrada en la planificación. Finalmente se determinó que, si bien ambas variables están conectadas, el comportamiento de una no obedece exclusivamente al comportamiento de la otra, por lo que se infiere que existen otras variables que inciden en ellas, entre estas el compromiso, la normativa general institucional y el trato mismo que dispensa el usuario al funcionario.

The purpose of the work was to determine the relationship between the organizational climate and quality management in the Degrees and Diplomas Division (DTD), an administrative unit of the Universidad Mayor de San Andrés (UMSA), a public and autonomous institution, responsible for professional, investigative and social academic training in the city of La Paz. For this, a quantitative methodology and a transactional correlational design were used; Three scales were developed that were validated and made reliable and then applied to officials and users of the DTD (selected through simple probabilistic samples and census); There was also an interview guide. The results show that the DTD has a participatory organizational climate in which leadership, teamwork and a positive vision of salaries and benefits received stand out; as weaknesses they highlight the physical work environment, job design and career development. Certification in quality management is the greatest strength to which customer orientation is added; the weakness in quality management is focused on planning. Finally, it will be concluded that, although both variables are connected, the behavior of one does not obey exclusively to the behavior of the other, so it is inferred that there are other variables that affect them, among them the commitment, the general institutional regulations and the same treatment that dispenses the user to the officer.

O objetivo do trabalho foi determinar a relação entre o clima organizacional e a gestão da qualidade na Divisão de Graus e Diplomas (DTD), unidade administrativa da Universidade Mayor de San Andrés (UMSA), instituição pública e autônoma, responsável pela gestão profissional, formação acadêmica investigativa e social na cidade de La Paz. Para tanto, utilizou-se uma metodologia quantitativa e um desenho correlacional transacional; foram desenvolvidas três escalas que foram validadas e tornadas confiáveis ​​e depois aplicadas a funcionários e usuários da DTD (selecionados através de amostras probabilísticas simples e censo); havia também um guia de entrevista. Os resultados mostram que o DTD possui um clima organizacional participativo em que se destacam a liderança, o trabalho em equipe e uma visão positiva dos salários e benefícios recebidos; os pontos fracos incluem o ambiente físico de trabalho, a concepção do trabalho e o desenvolvimento da carreira. A certificação em gestão da qualidade é o maior ponto forte ao qual se soma a orientação para o cliente; A fraqueza na gestão da qualidade está focada no planejamento. Por fim, determinou-se que, embora ambos ases variáveis estejam conectadas, o comportamento de uma não obedece exclusivamente ao comportamento da outra, pelo que se infere que existem outras variáveis que as afetam, incluindo o comprometimento, as regulamentações institucionais gerais e o mesmo tratamento que o usuário dá ao funcionário.

Cooperación entre médicos del departamento de emergencias y dermatólogos por telemedicina / Cooperation between emergency department physicians and dermatologists via telemedicine

Las intercurrencias dermatológicas agudas son un motivo de consulta frecuente a las centrales de emergencias, y generalmente los médicos de atención primaria se ocupan del primer nivel de atención. Puede ser necesaria una interconsulta con expertos, aunque no siempre estén disponibles. Ante la necesidad de facilitar dicha interacción a distancia, en Julio 2022 se implementó una herramienta de teledermatología en un hospital de alta complejidad en Buenos Aires, Argentina. Este servicio se limitó a días hábiles con horario restringido, permitiendo la comunicación entre médicos del departamento de emergencias y dermatólogos, a través de WhatsApp institucional. El dermatólogo podía verificar datos de salud relacionados al paciente (ej: comorbilidades y medicación crónica) mediante revisión de la historia clínica electrónica, para decidir sobre un plan de acción. Se evaluó la perspectiva de los usuarios a través de un formulario electrónico tras 3 meses de implementación. Los resultados evidenciaron que la mayoría (85%) de los profesionales conocía la herramienta, y el 57% la había usado al menos una vez. Se obtuvo una mediana de 9 puntos (de una escala de Likert del 1 al 10) sobre la recomendación hacia otro profesional. El teletriage dermatológico resultó beneficioso y fue aceptado, tanto por médicos de guardia como por especialistas. Ante las demoras en la atención ambulatoria, ha resultado una alternativa útil para evitar derivaciones innecesarias y/o acelerar aquellas que verdaderamente lo ameritan. Sin embargo, representa una forma de comunicación informal desde el punto de vista de almacenamiento de datos. Será necesario reflexionar sobre estos tópicos pendientes de esta experiencia asistencial como legalidad, seguridad y confidencialidad (AU)

Acute skin conditions are a frequent reason for consultation in emergency departments, and primary care physicians generally handle them. They might require referrals to experts, who are not always readily available. Recognizing the need to facilitate such interactions remotely, a teledermatology triage tool was implemented in July 2022 at a high-complexity hospital in Buenos Aires, Argentina. The service was limited to business days with restricted hours, enabling communication between emergency department physicians and dermatologists through institutional WhatsApp. Dermatologists could access patient-related health data (e.g., comorbidities and chronic medication) through the electronic medical record to determine an appropriate course of action. The perspective of users was evaluated through an electronic questionnaire after three months of application. Results showed that most professionals were aware of the tool (85%), and 57% used it at least once. The median rating for recommending the tool to other professionals was 9 points (on a Likert scale from 1 to 10). Dermatological teletriage proved beneficial and was well-received by emergency physicians and specialists. In the face of delays in outpatient care, it has been a useful alternative to avoid unnecessary referrals and expedite those that are warranted. However, it represents an informal method of communication with regard to data storage. It will be necessary to rethink on improvements in pending topics such as legal limitations, security, and confidentiality of this healthcare experience (AU)

Causas médicas de exención para el servicio militar obligatorio durante el siglo XIX en Jerez de los Caballeros, Badajoz, España / Medical causes of exemption for compulsory military service during the 19th century in Jerez de los Caballeros, Badajoz, Spain / Razões médicas para isenção do serviço militar obrigatório durante o século XIX em Jerez de los Caballeros, Badajoz, Espanha

Introducción: el objeto del estudio es la población de Jerez de los Caballeros (Badajoz). Debido a la implantación del Servicio Militar obligatorio en España, el reclutamiento se efectuaba basándose en los censos de los Ayuntamientos, eligiendo a una quinta parte de los mozos sorteables. Objetivo: exponer las causas de exención por parte de los quintos para no realizar el Servicio Militar, durante el siglo XIX. Material y métodos: la investigación en el Archivo Histórico Municipal de Jerez de los Caballeros, así como en publicaciones actuales y de la época, refiriendo las patologías médicas esgrimidas según la Clasificación Internacional de Enfermedades de Jacques Bertillon. Resultados: los mozos utilizaban toda clase de argumentos, entre ellos patologías médicas, reales o no, para eludir el Servicio Militar, el cual era muy cuestionado en la época, y que suponía muchas veces una sentencia de muerte para el quinto, debido a los frecuentes conflictos militares en los que estuvo envuelta España durante el siglo XIX. Discusión: el sorteo se efectuaba mediante unos bombos de manera pública, pero se podía evitar la realización del Servicio Militar, mediante el pago de una cantidad, o sustituciones, lo que suponía una gran discriminación. Conclusiones: a consecuencia del descontento popular que suponía el Servicio Militar obligatorio, los mozos seleccionados esgrimían toda clase de excusas para eludir su realización, circunstancia que fue aumentado con el correr de los años, y por consecuencia también la cantidad de quintos que lo lograban.

Introduction: the object of the study is the population of Jerez de los Caballeros (Badajoz). Due to the implementation of the obligatory Military Service in Spain, the recruitment was carried out based on the census of the City Councils, choosing a fifth part of the drawable young men. Objective: to expose the causes of exemption on the part of the fifth for not performing the Military Service, during the 19th century. Material and methods: research in the Municipal Historical Archive of Jerez de los Caballeros, as well as in current and period publications, referring to the medical pathologies used according to Jacques Bertillon's International Classification of Diseases. Results: the young men used all kinds of arguments, among them medical pathologies, real or not, to avoid the Military Service, which was very questioned at the time, and which was often a death sentence for the fifth, due to the frequent military conflicts in which Spain was involved during the 19th century. Discussion: the lottery was carried out by means of a public drawing of lots, but the Military Service could be avoided by paying an amount, or substitutions, which meant a great discrimination. Conclusions: as a consequence of the popular dissatisfaction with the compulsory military service, the selected young men used all kinds of excuses to avoid performing it, a circumstance that increased over the years, and as a consequence, so did the number of young men who did so.

Introdução: o objeto de estudo é a população de Jerez de los Caballeros (Badajoz). Devido à introdução do serviço militar obrigatório na Espanha, o recrutamento foi realizado com base nos censos dos conselhos municipais, sendo selecionado um quinto dos jovens elegíveis. Objetivo: expor as causas da isenção por parte dos quintos por não prestarem o serviço militar durante o século XIX. Material e métodos: pesquisa no Arquivo Histórico Municipal de Jerez de los Caballeros, bem como em publicações atuais e da época, referentes às patologias médicas utilizadas de acordo com a Classificação Internacional de Doenças de Jacques Bertillon. Resultados: os jovens usaram todos os tipos de argumentos, incluindo patologias médicas, reais ou não, para evitar o serviço militar, que era altamente questionado na época e que muitas vezes significava uma sentença de morte para o quinto, devido aos frequentes conflitos militares nos quais a Espanha estava envolvida durante o século XIX. Discussão: o sorteio era realizado por meio de um sorteio público, mas o serviço militar podia ser evitado mediante o pagamento de uma taxa ou substituições, o que significava uma grande discriminação. Conclusões: como resultado do descontentamento popular com o serviço militar obrigatório, os jovens selecionados usaram todos os tipos de desculpas para não cumpri-lo, uma circunstância que aumentou com o passar dos anos e, consequentemente, também o número de recrutas que o cumpriram.

O efeito da pandemia por covid-19 no atendimento da síndrome coronariana aguda: coorte retrospectiva / The impact of the covid-19 pandemic on the management of acute coronary syndrome: a retrospective cohort study

OBJETIVO: avaliar a contribuição da pandemia por COVID-19 sobre os tempos de atendimento e desfechos clínicos de admissões relacionadas à Síndrome Coronariana Aguda. MÉTODO: Coorte retrospectiva. Os dados foram analisados pelo SPSS, versão 20.0, empregados em testes paramétricos e não paramétricos para comparar os grupos. Aplicado o Modelo linear generalizado para análise multivariada. RESULTADOS: Incluídos 434 pacientes no período pré-pandemia e 430 durante a pandemia. Delta-t foi maior no período durante a pandemia (p=0,003). Não encontramos diferença nos tempos de atendimento e mortalidade. Admissão no período da pandemia (RR1,56; IC95%:1,30-1,87) e ter diagnóstico de cardiopatia isquêmica prévio (RR1,82; IC95%:1,50-2,20) foram associados ao aumento do Delta-t. CONCLUSÃO: Não houve diferença no número de pacientes que acessou a emergência por Síndrome Coronariana Aguda nos períodos analisados. Apesar do Delta-t ter sido maior durante a pandemia, não foram observados piores desfechos clínicos.

OBJECTIVE: To assess the impact of the COVID-19 pandemic on response times and clinical outcomes of acute coronary syndrome admissions. METHOD: Retrospective cohort study. Data were analyzed using SPSS version 20.0 with parametric and non-parametric tests for group comparisons. Generalized linear modeling was used for multivariate analysis. RESULTS: 434 patients were included in the pre-pandemic period and 430 during the pandemic. Delta-t was higher during the pandemic period (p=0.003). There were no differences in response times and mortality. Admission during the pandemic period (RR 1.56; 95% CI: 1.30-1.87) and a previous diagnosis of ischemic heart disease (RR 1.82; 95% CI: 1.50-2.20) were associated with increased delta-t. CONCLUSIONS: There was no difference in the number of patients presenting to the emergency department with acute coronary syndrome during the periods analyzed. Despite longer Delta-t during the pandemic, no worse clinical outcomes were observed.

Let ′Rare Disease′ Been Seen: Delving into the Building up of Resource and Information Service in Medical Libraries for Rare Diseases / 罕见病研究

With the development of the diagnosis and treatment for rare diseases and the promotion of the construction of ′Double First-Class′ Universities in China, the libraries of medical schools have to make full use of their strengths to better face new challenges in discipline construction proactively. This article refers to resource and information service practices related to the rare disease carried out by medical libraries in China and in other countries; explores the possibilities of building up the resource and information in the future, aiming at improving the awareness of rare diseases among medical students, researchers, and the general public. The article also focuses on the need for strengthening the support for teaching and research into rare diseases, hoping to contribute to the overall improvement of the diagnosis, treatment, and educational research in rare diseases in China.

Application of FMEA model and 6S management method in reducing dispensing errors in PIVAS of children’s hospitals / 中国药房

OBJECTIVE To reduce dispensing errors in pharmacy intravenous admixture service （PIVAS） of children’s hospitals. METHODS The risk of dispensing procedures in our PIVAS was identified by applying failure mode and effect analysis （FMEA） model. Potential failure modes that might lead to dispensing errors in each link were determined， and failure causes were analyzed. The severity， incidence and detection degree of potential failure modes were quantitatively scored， and their risk priority number （RPN） was calculated to screen failure modes that needed to be improved in priority； the corresponding improvement measures were developed by 6S management method from six aspects， namely， finishing （seiri）， rectifying （seiton）， sweeping （seiso）， sanitation （seiketsu）， literacy （shitsuke） and safety. The effect of intervention before and after rectification was evaluated. RESULTS Based on the RPN， 32 potential failure modes were selected， of which a total of 18 critical failure modes that needed to be improved in priority. After implementing corresponding measures according to 6S management method， the RPN of 18 critical failure modes decreased. The total RPN decreased from 497 to 142 with a decrease rate of 71.43%. The error rates of 15 critical failure modes were significantly lower than before implementation （P＜0.05）. CONCLUSIONS Applying FMEA model and 6S management method to the risk control of all aspects of PIVAS workflow can effectively reduce the risk of PIVAS dispensing errors and ensure the safety of children’s intravenous medication.

Whole Process of Pharmaceutical Service Pathway for Breast Cancer Patients in Medical Institutions / 医药导报

Objective To formulate a pharmaceutical service pathway to standardize the pharmacists'whole process of pharmaceutical services for breast cancer patients in medical institutions,promote the standardization of pharmacists'work and improve the rationality of drug use for breast cancer patients in medical institutions.Methods The editorial committee aimed at several challenging problems in the whole process of pharmaceutical services for breast cancer patients in medical institutions through systematic search,referring to the latest domestic and international guidelines and expert consensus of breast cancer and under the relevant drug administration regulations in China,collected and sorted out the professional opinions of doctors,pharmacists,and methodological experts,developed questionnaires and held two rounds of expert argumentation meetings,and finally screened out the most valuable results.The whole process management pathway of pharmaceutical care for breast cancer patients was formulated,and the referral principles of hospitals at different levels and the contents of pharmacist training and assessment were clarified.Results The whole process management pathway of pharmaceutical services for breast cancer patients was developed,including information collection,analysis,evaluation,development implementation of intervention plans,and follow-up.Conclusion This pharmaceutical service pathway can standardize and guide pharmacists in hospitals at different levels to carry out pharmaceutical services for breast cancer patients,achieve the whole process of monitoring drug use,and ensure rational drug use and treatment effectiveness for patients.

(MTM)Against the Background of"Internet+"Based on CiteSpace / 医药导报

Objective To analyze the current status of medication therapy management(MTM)against the background of"Internet+"in China,to reveal its research hotspots and development trend through visual methods,and to provide a firm reference for promoting innovative pharmaceutical development and the transformation of pharmacists.Methods Using CiteSpace 6.2 R2,368 Chinese studies from the CNKI,CBM,and VIP databases were collected and analyzed.Relevant graphs were drawn,and the results were analyzed through post-trend,cooccurrence,cluster,and burst analysis.Results The number of articles issued in China's"Internet+"MTM field is on the rise.However,the cooperation network between authors and research institutions is relatively scattered.The research team led by tertiary hospitals has played an essential role in this field,but the medical consortium has not fully utilized its advantages.In addition,informatization and pharmacists are the research objects of continuous concern,while quality of life and diabetes are recent research hotspots.Conclusion"Internet+"MTM is a new medical service model involving multiple disciplines and fields.In this paper,CiteSpace 6.2 R2 performed a visual analysis of the literature on"Internet+"medication therapy management in China,revealing the research status,concerns,and development trends in this field,which has specific reference value for relevant policy formulation and research.

Practice Advances of Family Pharmacist in Domestic and Aboard Based on CiteSpace / 医药导报

Objective To analyze and discuss the current research status,hotspots,frontiers,and progress in work practice of family pharmacists both in domestic and abroad by Citespace.Methods The database of Web of Science Core Collection and CNKI were selected for data extraction.They searched for literature from the database from establishment to April 1,2023 using the topic words"family pharmacist"and"home pharmaceutical care"both in Chinese and English.The network diagrams of essential nodes such as authors,countries,institutions,and key words were analyzed and drawn Results A total of 439 Chinese and 572 English literatures were included in the study.Scholars such as Mei Shen,Shihui Bao,Zhongzhuang Wang,Hughes Carmel M,Jamieson Hamish A,and Chen Timothy F have significantly contributed.The UK and the United States were leading countries in family pharmacists.Most of China's top ten research institutions were from Shanghai,Beijing.The top five Chinese literature keywords were pharmaceutical care,community,pharmacist,rational drug use,family pharmacist.The top five English literature keywords were pharmaceutical care,care,management,older people,and impact.Conclusions According to keyword clustering and burst analysis,research hotspots in foreign countries mainly focus on pharmaceutical services,adverse drug reactions,adherence,etc.,which is consistent with the development direction of pharmaceutical services in China.However,domestic pharmacy's development and literature publication are slightly behind those of foreign countries,and there is still some development space for pharmaceutical services in China.

Quality monitoring indicator system in blood banks of Shandong: applied in blood donation services, component preparation and blood supply process / 中国输血杂志

【Objective】 To establish an effective quality indicator monitoring system, scientifically and objectively evaluate the quality management level of blood banks, and achieve continuous improvement of quality management in blood bank. 【Methods】 A quality monitoring indicator system that covers the whole process of blood collection and supply was established, the questionnaire of Quality Monitoring Indicators for Blood Collection and Supply Process with clear definition of indicators and calculation formulas was distributed to 17 blood banks in Shandong. Statistical analysis of 21 quality monitoring indicators in terms of blood donation service (10 indicators), blood component preparation (7 indicators ), and blood supply (4 indicators) from each blood bank from January to December 2022 were conducted using SPSS25.0 software The differences in quality monitoring indicators of blood banks of different scales were analyzed. 【Results】 The average values of quality monitoring indicators for blood donation service process of 17 blood banks were as follows: 44.66% (2 233/5 000) of regular donors proportion, 0.22% (11/50) of adverse reactions incidence, 0.46% (23/5 000) of non-standard whole blood collection rate, 0.052% (13/25 000) of missed HBsAg screening rate, 99.42% (4 971/5 000) of first, puncture successful rate, 86.49% (173/200) of double platelet collection rate, 66.50% (133/200) of 400 mL whole blood collection rate, 99.25% (397/400) of donor satisfaction rate, 82.68% (2 067/2 500) of use rate of whole blood collection bags with bypass system with sample tube, and 1 case of occupational exposure in blood collection.There was a strong positive correlation between the proportion of regular blood donors and the collection rate of 400 mL whole blood (P<0.05). The platelet collection rate, incidence of adverse reactions to blood donation, and non-standard whole blood collection rate in large blood banks were significantly lower than those in medium and small blood banks (P<0.05). The average quality monitoring indicators for blood component preparation process of 17 blood banks were as follows: the leakage rate of blood component preparation bags was 0.03% (3/10 000), the discarding rate of lipemic blood was 3.05% (61/2 000), the discarding rate of hemolysis blood was 0.13%(13/10 000). 0.06 case had labeling errors, 8 bags had blood catheter leaks, 2.76 bags had blood puncture/connection leaks, and 0.59 cases had non-conforming consumables. The discarding rate of hemolysis blood of large blood banks was significantly lower than that of medium and small blood banks (P<0.05), and the discarding rate of lipemic blood of large and medium blood banks was significantly lower than that of small blood banks (P<0.05). The average values of quality monitoring indicators for blood supply process of 17 blood banks were as follows: the discarding rate of expired blood was 0.023% (23/100 000), the leakage rate during storage and distribution was of 0.009%(9/100 000), the discarding rate of returned blood was 0.106% (53/50 000), the service satisfaction of hospitals was 99.16% (2 479/2 500). The leakage rate of blood components during storage and distribution was statistically different with that of blood component preparation bags between different blood banks (P<0.05). There were statistically significant differences in the proportion of regular blood donors, incidence of adverse reactions, non-standard whole blood collection rate, 400 mL whole blood collection rate, double platelet collection rate, the blood bag leakage rate during preparation process, the blood components leakage rate during storage and distribution as well as the discarding rate of lipemic blood, hemolysis blood, expired blood and returned blood among large, medium and small blood banks (all P<0.05). 【Conclusion】 The establishment of a quality monitoring indicator system for blood donation services, blood component preparation and blood supply processes in Shandong has good applicability, feasibility and effectiveness. It can objectively evaluate the quality management level, facilitate the continuous improvement of the quality management system, promote the homogenization of blood management in the province and lay the foundation for future comprehensive evaluation of blood banks.

Review of Price Management Policy,Scheme Comparison on Special Demand Medical Service in Public Hospitals and Its Enlightenment / 中国卫生经济

The special demand medical services meet the diversified and personalized medical demands of the masses,and are the feedbacks of basic medical service.On the basis of searching and reviewing the policy documents on the price management of special demand medical service in public hospitals at the national level,it sorts out the key points and shortcomings of the current policy texts,and uses the thematic framework method and comparative analysis method to cover the application conditions for carrying out special demand,the scale control of special demand services the charging standard of special demand service,and the dimensions of the price supervision of special demands services.The specific provisions vary from provinces.Strengthening the management of the price of special medical services in public hospitals,in terms of system design,promoting the beneficial experience of typical provinces,and improving the project management program of the price of special medical services;in terms of implementation,the provision of special services in accordance with the published price items and the control of the size of the service,and the independent pricing and filing of the record.

Analysis of Influencing Factors of Medical Service Price Dynamic Adjustment Based on the DEMATEL / 中国卫生经济

Objective:To provide suggestions for figuring out the price formation mechanism of medical services by studing the in-fluencing factors of the price dynamic adjustment and identify the relationship among the factors.Methods:The price policies and published literature were searched for preliminarily screening out the influencing factors of the prices dynamic adjustment.The influ-encing factors and their relationship were analyzed by decision-making trial and evaluation laboratory and expert consultation method.Results:A total of 9 cause factors and 6 result factors were selected.In the cause reasons,the change of service factor cost,the de-gree of leadership support and the price relationship of medical service were in the top three;among the outcome factors,the level of medical burden of the masses,patients'satisfaction with price and actual financial compensation ability were more susceptible to other factors.Conclusion:Promoting the reform of medical service prices dynamic adjustment by reasonably calculating the cost of medical service factors,increasing the price adjustment attention of leaders,straightening out the price relationship of medical services,paying full attention to the level of medical burden of the masses and patients'satisfaction with price and improving the substantial financial compensation capacity of institutions for policy losses.

Policy Evolution,Implementation Dilemma and Breakthrough on Medical Service Price Items Normative Management and Its Enlightenment / 中国卫生经济

It reviewed the policies related to the standardized management of medical service price items,analyzed the current difficulties in the implementation of medical service price regulations:the technical specifications of national medical service price item are heavy and cannot be dynamically adjusted with technological innovation;provincial level item access control is not strict,and the elements of the same price item are not completely unified,affecting the horizontal comparison.The policy suggestions to speed up the improvement of the medical service price item specifications include:medical services that are allowed to be applied and have clear technical specifications are accepted as the scope of new price item declaration;promote the separation of technology and consumption,except for consumables and reagents,which are priced separately according to service items+special consum-ables;priority should be given to responding to the legitimate demand for medical technology improvement innovations through cur-rent price item compatibility;contrast technical specifications and item guidelines,integrating current price items,improving item standardization and compatibility;complete the innovation and economic evaluation of the newly declared item price,check the quality,and reasonably determine the increment.

Practice Progress and Enlightenment of Promoting Medical Service Price Reform in the Pilot Cities / 中国卫生经济

Based on the relevant policy documents of deepening medical service price reform in the pilot cities,combined with research and interviews,it analyzes the practical progress of measuring the total amount of medical service price adjustments in the pilot cities and the overall distribution of the total amount,the classification of items for pricing and dynamic adjustment,and the monitoring and assessment.It is suggested to explore the construction of a concise indicator system and a practical measurement method,consider the sustainability of the total price adjustment of medical services,and continue to optimize and improve the price adjustment mechanism of medical service price items.

Analysis on the Problems of Nurses'Labor Cost Accounting from the Perspective of Management Accounting and Industry Finance Integration / 中国卫生经济

Nurses not only focus on nursing fees,but also participate in other medical fees,which is an important part of the hospital's medical services for patients.For the main resource consumption-labor cost in medical service project cost accounting,the labor cost of doctors(including medical and technical staff)and nurses is the most important part,but the labor cost accounting of nurses has not been paid enough attention for a long time.From the perspective of management accounting and the integration of industry and finance,it analyzes the characteristics of nurses'labor cost and accounting,and studies and discusses some problems of medical service project cost accounting based on nurses'labor cost,hoping to provide references for hospitals to carry out nurses'labor cost accounting in medical service projects more scientifically and reasonably.

The Medical Insurance Payment Method for Medical Services Provided by Canadian Medical Personnel and the Implications for China / 中国卫生经济

It summarizes the practical experience of medical insurance payment methods for medical services provided by Canadian medical staff,covering payment methods for medical services and alternative payment methods.Taking into account the current situation and conditions of the medical insurance payment method for medical services provided by medical personnel in China,it proposes policy recommendations for exploring diversified payment models,introducing direct settlement of health insurance,optimizing payment methods,considering regional differences,and ensuring the long-term sustainability of healthcare personnel health insurance payment methods.

Analysis of the management and service mechanisms in the integration dilemma of medicine and prevention in China / 中国卫生政策研究

This paper analyzes the main obstacles in the process of promoting the integration of medicine and prevention in China,including the mindset of prioritizing medical care over prevention,fragmented system architecture,conflicting direction of funding and incentives,and inherent contradictions in the division of labor and cooperation in service provision.Furthermore,this article attempts to present the current status and constraints of medical and health integration in China from the perspectives of management mechanisms and service mechanisms,highlighting the mismatch between these two aspects as the root cause.It proposes that the reform logic of current medical and health integration practices should prioritize the service mechanism.This involves clarifying the service interface of medicine and prevention integration and establishing patient-centered service pathways for integration.In the establishment of the service mechanism,a balance should be struck between efficiency and quality,while also integrating based on division of labor.Subsequently,adjustments to the management mechanism should be made in accordance with the medicine and prevention integration service mechanism.In the reform of the management mechanism,various stakeholders'interests should be coordinated and the costs of reform should be controlled.

The regulation and guidance of long-term care insurance to the demands of home and community-based care:International experiences and implications / 中国卫生政策研究

In order to implement a"people-centered"service concept and promote the sustainability of long-term care systems,countries worldwide are increasingly focusing on benefit package design when allocating and using public long-term care funds.This emphasis is aimed at regulating and guiding long-term care demand and developing home and community-based care.Based on the purchasing theory,this study categorized the long-term care benefit package models in representative countries into two types:"Institutional Eligibility Restrictions Type"and"Home-care-focused Benefit Type",and further elaborated the specific benefit package design.In China,long-term care insurance are still in the initial stages of development.We should optimize the service utilization structure and promote a rational allocation of resources through purchasing,while incorporating diverse benefit designs such as eligibility restrictions,differential benefit levels,and supplementary support,to establish a robust,multi-tiered long-term care system based on home and community-based care.

Exploring doctors'motivation of value-based health care delivery in public hospitals in China:Concept construction and measurement / 中国卫生政策研究

The Healthy China construction initiative highlights the concept of patient-centered value-based health care,and the value appeal of doctors'medical service is also increasing.This study attempts to introduce the concept of public service motivation in general public organizations into professional public healthcare organizations——public hospitals,and proposes the concept of"value-based medical service motivation"as an expression of public service motivation for doctors in public hospitals.Through qualitative analysis and quantitative measurement,this paper constructs the concept of"public hospital doctors'value-based medical service motivation",finds its conceptual structure,namely responsibility commitment,professional adherence,reputation maintenance,and norm compliance,and finally forms a value-based medical service motivation scale.This paper confirms that doctors in public hospitals in China have multi-dimensional value-based medical service motivation,present different motivational expressions or behavioral tendencies,and constantly deal with and balance the public value tensions in the practice of realizing the patient-centered value-based medical goal.This scale provides an effective tool for measuring doctors'value-based service motivation,and provides theoretical and practical support for further investigating the influencing factors of doctors'motivation for value-based medical services,improving the medical service capacity of public hospitals,adjusting medical behavior,and advancing doctor-patient trust.