实施风险导向内部审计 防范医院财务风险

文章介绍了医院风险导向内部审计、医院财务风险的含义及医院风险导向内部审计在防范医院财务风险中的作用,对加强风险导向内部审计、防范医院财务风险的对策进行了探讨。     

新型农村合作医疗设计与管理中的风险及风险规避

如何认识新型农村合作医疗项目可能发生的风险,在设计和管理中有效地防范风险的发生是新型农村合作医疗可持续发展的重要课题。根据医疗保险的基本原理,结合新型农村合作医疗工作的实际,总结概述新型农村合作医疗可能会遇到的几种风险,并提出规避风险的常用方法     

风险沟通和公共卫生

本文罗列了若干有关风险沟通及公共卫生的观点和看法,旨在通过解析风险、风险沟通的概念和相关理论,分析风险评估、风险管理和风险沟通之间的关联以及探寻风险沟通过程中的合作方的收益与阻碍、执行原则和有效风险沟通实践过程并列举风险沟通的实例例证,来说明风险沟通与公共卫生的关联,风险沟通如何提高处理突发公共卫生事件的实效性以及对如何应对突发公共卫生事件的长远潜在影响。     

论疾病风险与医疗风险

目的：根据疾病风险与医疗风险的特征、区别与联系,探讨风险责任的公平承担原则与方式。方法：根据医学科学的一般原理,结合马克思主义哲学以及当今中国的法律制度,分析疾病风险与医疗风险各自特征、相互作用以及对患者的影响。明确不同风险的承担主体。结果：疾病风险与医疗风险既有本质区别又有必然联系,不同的风险应有不同的承担主体。医疗过错风险具有主观过失性、可能动控制性和不可避免性。医疗机构和医务人员应当只对医疗过错风险承担有限责任。结论：正确处理医患纠纷,必须分清疾病风险、医疗非过错风险和医疗过错风险,严格执行医疗过错风险责任承担制度、风险后果责任制度和有限责任制度。在保护患者合法权益的同时,注重对医疗机构和医务人员合法权益的保护,这样才有利于构建和谐的医患关系。     

论疾病风险与医疗风险

目的：根据疾病风险与医疗风险的特征、区别与联系,探讨风险责任的公平承担原则与方式。方法：根据医学科学的一般原理,结合马克思主义哲学以及当今中国的法律制度,分析疾病风险与医疗风险各自特征、相互作用以及对患者的影响。明确不同风险的承担主体。结果：疾病风险与医疗风险既有本质区别又有必然联系,不同的风险应有不同的承担主体。医疗过错风险具有主观过失性、可能动控制性和不可避免性。医疗机构和医务人员应当只对医疗过错风险承担有限责任。结论：正确处理医患纠纷,必须分清疾病风险、医疗非过错风险和医疗过错风险,严格执行医疗过错风险责任承担制度、风险后果责任制度和有限责任制度。在保护患者合法权益的同时,注重对医疗机构和医务人员合法权益的保护,这样才有利于构建和谐的医患关系。     

手术风险的告知

手术是一种具有创伤性的治疗方法，任何手术对病人来说都是一种外来伤害。手术治疗具有一定的危险性，存在医疗风险，可能产生不良后果。手术创伤可以严重影响病人机体内环境的稳态，加重病人的生理负担，也可能产生不同程度的心理压力。手术可能成功，也可能失败，甚至危及患者的生命。因此手术风险的告知在临床外科治疗过程中是一项重要的工作。     

营养风险的概念分析

任何概念都存在区别于其他概念的特征和规则,而概念分析是明确特定概念内在结构和功能的过程,目的是找出该概念普遍适用的规则及这些规则如何呈现。概念分析对澄清概念含义、发展新理论、发展新研究工具、评价已有工具均具有重要意义。概念分析有几种固定模式,目前常用的概念分析方法包括下列过程：（1）选择概念;（2）明确分析目的;（3）检索相关文献,分析目前已有的所有定义;     

公立医院融资风险及其管理策略探讨

描述了公立医院融资风险的概念及主要表现形式,提出融资风险的风险回避策略、损失控制策略、风险转嫁策略,并建议采取积极措施,构建公立医院融资风险管理系统、建立有效的融资风险预警机制、提高财务决策的科学化水平、建立明晰的领导任期内经济责任制,以有效防范风险的发生。     

医疗风险预警及控制机制探讨

目前我国医疗纠纷及其伤医事件频发,医疗风险预警及控制机制的不健全、医患沟通不畅及信任危机是造成这种冲突的主要原因.通过对医疗风险预警及控制机制的研究,为政府和医疗机构在减少医疗风险的发生上提供干预措施和参考依据.     

营养风险理念解读

营养风险是指与营养因素有关的出现临床并发症的风险,而不是出现营养不良的风险。通过发现患者的营养风险,预测患者的临床结局,监测患者使用临床营养支持的效果。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Fatigue and health in a seafaring population

Background Occupational fatigue is relatively common withinthe general population and has been linked to reduced performance,injury and longer term ill-health. Despite growing acknowledgementof this problem in the maritime sector, little research hasbeen conducted into the risk factors, prevalence and consequencesof seafarers' fatigue. Aims To examine the prevalence of fatigue among seafarers, identifypotential risk factors and assess possible links with poor performanceand ill-health. Methods Cross-sectional questionnaire survey of seafarers workingin the offshore oil support, short-sea and deep-sea shippingindustries. A number of tools were used including the fatiguesubscale of the profile of fatigue-related symptoms, the CognitiveFailures Questionnaire, the General Health Questionnaire andthe SF36 General Health scale. Results In all, 1855 questionnaires were completed giving anoverall response rate of 20%. Fatigue symptoms were associatedwith a range of occupational and environmental factors, manyunique to seafaring. Reporting a greater number of risk factorswas associated with greater fatigue [e.g. OR = 2.53 (1.90–3.35)for those with three or four risk factors and OR = 9.54 (6.95–13.09)for those with five or more risk factors]. There was also astrong link between fatigue and poorer cognitive and healthoutcomes, with fatigue the most important of a number of riskfactors, accounting for 10–14% of the variance. Conclusions Seafarers' fatigue could impact on safety withinthe industry and may be linked to longer term individual ill-health.It can only be addressed by considering how multiple factorscombine to contribute to fatigue.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.